Encroachment Permit Application 7.1.23 (Roll Off)Please submit to the Engineering Department electronically by emailing the completed application to encroachments@pismobeach.org
rev. 7/1/2023
ADDRESS OF PROJECT LOCATION:
OWNER:
ADDRESS:
CITY/STATE/ZIP:
CONTACT PERSON: TELEPHONE#:
Please check type of telephone: ☐ Cell / ☐ Office / ☐ Home
START DATE: ________________END DATE:__________________
DESCRIPTION OF WORK:________________________________________________________________
ENCROACHMENT PERMIT SUBMITTAL 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 $74 (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
ENCROACHMENT PERMIT APPLICATION ENGINEERING DIVISION