C Ave rain garden encr permit app ENG20160412.pdfOF ED41
S. �.
ZF1 ENCROACHMENT PERMIT APPLICATION
ADDRESS OF PROPOSED PUBLIC USE: �-e
PROPERTY OWNER NAME., �IVvL �a+ r� �" 'CONE: ..............
PROPERTY OWNER MAILING ADDRESS: ` I � � � ��'1 #�_.�—����'� C?1W►�3 i C 0 Lw
CONTACT NAME:
7-CJ1-:,^ 4Ld-�- 0--16'�R
CONTACTEMAIL ADDRESS: G � C � A : � V, y, .
Describe the portion of public space, City right-of-way or easement area to be utilized (i.e., overhead space of
sidewalk, 10 foot City utility easement alopg north property line, etc): r j
Describe the type of encroachment or use desired (i.e., fence 6 feet by 150 feet, awning 3 feet wide by 7 feet
long, etc.):
- DEPARTMENT APPROVALS ---FOR CITY USE ONLY
Division Approved By ADB# Date
Public Works Approved By
Remarks or Comments:
Engineering Division Approved
Certificate of Insurance Verified By Date
Encroachment Agreement sent to City Clerk for recording Date
ENCROACHMENT PE�RM]T# SSUANCE DATE
- 1 -
UILD"IG PERMIT #WRECORDING # 12414 1 Uq 02,1