Encroachment Permit Application 7.1.22 (Roll Off)Please submit to the Engineering Department (805)773-4656 For questions or submittal of requirements email mkacsinta@pismobeach.org
rev. 7/1/2022
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 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 $71 (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