Encroachment Permit

This application shall be the formal request to encroach or make an improvement(s) on, under, or above City property and those public rights-of-way. Applications for encroachment will not be accepted unless accompanied by a completed application, project plans, proof of general liability insurance, payment of application fees, and any supplemental documentation which may be deemed necessary (i.e. performance bond, maintenance bond, agreements).

Applicant Information

Name/Organization:

Phone:

Email:

Contractor Information

(If different from above)

Name/Organization:

Phone:

Email:

Work Location

Provide nearest address or approximate feet from nearest intersection including which side of the street the work will be performed:

Project Description

Requested Start Date:

Month

Day

Year

Estimated Completion Date:

Month

Day

Year

Please describe the proposed work, including type of encroachment (saw cut, utility services, excavation, permanent / temporary improvement, etc.) and description of encroachment location (street, alley, sidewalk, berm, etc.):

By placing a signature below, the Applicant acknowledges, understands, and agrees to the accompanying Terms and Conditions for Encroachment Permit and will abide by all terms and conditions as more fully described herein.

Applicant Signature:

Date:

Month

Day

Year

City Official Signature:

Date:

Month

Day

Year