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Encroachment Permit Application In Compliance With Alpine County Code 12.08 and California Streets & Highways Code The Undersigned Hereby Applies For Permission To Construct The Following Improvement Or Otherwise Encroach Upon A County Road Reservation Or Right Of Way, As Follows: Complete all items below. If item is not applicable enter Application is not complete until all required attachments are included. Situs Address: APN: Applicant Name: Applicant Phone Applicant Address: Applicant Email: Excavation: Max Average Average Road Surface Pipes: Voltage or On What Side of the County Road will the work be Performed: North South East West FULLY DESCRIBE WORK TO BE PERFORMED WITHIN COUNTY RIGHT OF WAY. (Who, What, Where, When, Why, How) Attach complete drawings sets) folded to 8.5”by 11” showing specifications, calculations, maps etc. Attach additional pages if necessary. Incomplete or illegible applications will be returned for correction. *Applicants for driveway encroachments must mark the intended driveway location by a stake with orange paint or flag bearing the applicants last name, the address, and the Assessor’s parcel number. Signature: Date: For County Use Only: Date Received: Application Received By: Surety Amount: Receipt Total Amount COUNTY OF ALPINE Community Development 50 Diamond Valley Rd Markleeville, CA 96120 [PHONE REDACTED] [PHONE REDACTED] Website: Alpinecountyca.gov ---PAGE BREAK--- Encroachment Permit Application Page 2 of 2 “ATTACHMENT A” Please use this space to draw your project diagram, and/or attach additional plans: PLAN VIEW PROFILE Alpine County Community Development ▪ 50 Diamond Valley Rd ▪ Markleeville, CA 96120 ▪ [PHONE REDACTED]