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Encroachment Permit Application 7.1.21 (Roll Off)Please submit to the Engineering Department (805)773-4656 For questions or submittal of requirements email mkacsinta@pismobeach.org rev. 7/1/2021 TELEPHONE#: ADDRESS OF PROJECT LOCATION: OWNER: ADDRESS: CITY/STATE/ZIP: CONTACT PERSON: Please select 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 $67 (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 andunderstand the permit requirements ENCROACHMENT PERMIT APPLICATION ENGINEERING DIVISION