This application must be submitted to begin the encroachment permit/license process. A completed application must be submitted to begin the process. You will be contacted by Engineering staff to complete the process.

BUSINESS CONTACT INFORMATION

1

Company contact

 *

Company contact

2

Title

 *

Title

3

Phone

 *

Phone

4

Email

 *

Email

5

Registered company name

 *

Registered company name

6

Registered company address

 *

Registered company address

7

City, State

 *

City, State

8

Zip code

 *

Zip code

9

Billing address (If different from above)

Billing address (If different from above)

10

City, State

City, State

11

Zip code

Zip code

12

Business Type

Business Type

Sole proprietorship

Partnership

Corporation

Other

13

Address or street name of encroachment:

 *

Address or street name of encroachment:

14

Description of encroachment and type of material used:

 *

Description of encroachment and type of material used:

15

Dimensions or square footage of right-of-way impacted by encroachment:

 *

Dimensions or square footage of right-of-way impacted by encroachment:

16

Full legal description of property address to proposed encroachment:

 *

Full legal description of property address to proposed encroachment:

17

SIGNATURE

 *

SIGNATURE

18

DATE

 *

DATE

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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