Encroachment Permit

Name of Applicant (Individual/Owner)

First Name (required)

Last Name (required)

Phone (required)

Email (required)

Property Address

Street Address (required)

Address Line 2

City (required)

State (required)

Zip Code (required)

Requested Start Date (mm/dd/yyyy) (required)

Requested Start Time (HH:MM AM/PM) (required)

Requested End Date (mm/dd/yyyy) (required)

Name of Contractor (If Applicable)

First Name

Last Name

Contractor Address (If Applicable)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Contractor State License Number (If Applicable)

Location of Encroachment

Reason for Encroachment

Type of Vehicle(s) accessing District Property or Right of Way

Has work commenced or encroachment occurred prior to receiving permit?

Yes

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