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PUBLIC RIGHT OF WAY ENCROACHMENT APPLICATION A licant's Name: A If applicant is a corporation, give State of incorporation and names of President and Secretary: Incorporation State: Location of encroachment: (EXAMPLE: The building stairway in the alley at 123 Main Street) Nature of permit desired: Applicant will submit blueprints or sketches of the proposed encroachment (give sufficient detail to permit thorough understanding) and attach them to this permit application. How long a period is the permit desired? (EXAMPLE: The life of the building.) Dated th is date of 2010. APPLICANT NAME (print): FOR CITY ENGINEERING USE ONLY Reviewed b : Date reviewed: K:\OOforms\ENCROACHMENTS\Application-PublicROWEncroachment.doc Updated: January 05, 2010 ---PAGE BREAK--- ---PAGE BREAK--- I I I I J I ,I 1 II llL l'l , I I II ~7 - I I I - ll j I m I co , I' , ---PAGE BREAK--- I ~ I