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Encroachment Permit Application - Roll-Off Dumpster 7.1.19Please submit to the Engineering Department (805)773-4656 For questions or submittal of requirements email mkacsinta@pismobeach.org rev. 7/1/2019 ADDRESS OF PROJECT LOCATION: OWNER: ADDRESS: CITY/STATE/ZIP: CONTACT PERSON: TELEPHONE#: Please circle type of telephone: Cell / Office / Home START DATE: ________________END DATE :__________________ DESCRIPTION OF WORK:________________________________________________________________ ENCROACHMENT PERMIT SUBMITTIAL CHECKLIST (to be filled out by City Employee) All of the following items must be submitted prior to issuance of encroachment permit: Application (All information completed) Permit Fee of $65 (minor; not requiring inspection) Start and End Date of Project (This may be updated at a later date if necessary) Signature of Applicant or Contractor on stating that they have read “The Permit” statement under the general provision and understand the permit requirements ROLL OFF/DUMPSTER ENCROACHMENT PERMIT APPLICATION ENGINEERING DIVISION