Encroachment Permit Form

Encroachment Permit Application

Applicant
Contact Person(Required)
Address
Property Owner
Name
Address
Project Location
Address

Type of Encroachment

Check all that apply

Entrance/Curb Cut
Utility
Building/Grade Work
Pavement Cut
****NOTE***** Please attach a descriptive drawing that shows the encroachment and its relation to any nearby existing utilities and/or structures. Application will not be approved without a drawing.
MM slash DD slash YYYY
MM slash DD slash YYYY
Restoration Plan Attached
Drop files here or
Max. file size: 128 MB.
    Traffic Control Plan Attached
    Drop files here or
    Max. file size: 128 MB.
      Consent(Required)
      Clear Signature
      Date
      Clear Signature
      Date