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UBLIC RIGHT OF WAY E CROACHMENT APPLICATION 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 , APPLICANT NAME (print): Signature: REMARKS: K:\OOforms\ENCROACHMENTS\Application-PublicROWEncroachment.doc Updated: January 17,2008 ---PAGE BREAK--- ---PAGE BREAK---