Encroachment Permit Application

LOCATION OF WORK:

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Location of Work: Street Address(Required)

City:(Required)

Zip Code:(Required)

Nearest Cross Street:

Distance from nearest Cross Street (FT):

DESCRIPTION OF WORK:(Required)

Excavation Length:

Excavation Width:

Excavation Depth:

Excavation Surface: (e.g. earth or pavement, etc.)

Start Date:(Required)

End Date:(Required)

Number of Driveways:

Width of Driveway/Sidewalk:

Length of Driveway/Sidewalk:

APPLICANT INFORMATION:

Permittee Name: Shall be the Property Owner(Required)

Street Address:(Required)

City:(Required)

Zip Code:(Required)

Permittee Phone:(Required)

Permittee Email:(Required)

Field Contact Name:(Required)

Field Contact Phone Number:

CONTRACTOR INFO:

Contractor/Agent Name:

Street Address:

City:

Zip:

Contractor Phone:

Contractor Email:

Field Contact Person:

Field Contact Person Phone:

Working in the road right of way without an approved permit is a misdemeanor and may be subject to double fees and other penalties.

Acknowledgement
I understand that any permit that may be granted as a result of this request may be revoked by the County at any time. In consideration for issuance of this permit, I agree, and by use hereof, my agents, employees, contractors and invitees agree to be bound by all of the provisions of California Vehicle Code Sections 35780, 35782, Division 12 of the Ventura County Ordinance Code, the Standard Conditions included with this permit and any special conditions hereupon, or attached hereto.

I agree to hold the County, its officials, officers, employees and agents harmless from any claims, defense and legal costs, judgements for damages, or other relief against the County as a result of acts, or omissions, by me or my representatives, in the performance of any activities permitted hereunder, whether the condition giving rise to the claim or judgement was created in whole, or in part, by me or my representatives.

I understand that a violation of the conditions would constitute a violation of the encroachment ordinance which is a misdemeanor per section 12301 and is guilty of separate offenses for every day and part thereof which such violation remains. I agree to comply with all conditions of approval for the permit. I further agree to continually maintain all encroachments authorized by this permit in condition acceptable to the County.

PRINT NAME:(Required)

Signature/Title(Required)

Owner/Permittee

Contractor

Agent

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Encroachment Permits Application

Encroachment Permit Application

LOCATION OF WORK:

APPLICANT INFORMATION:

CONTRACTOR INFO: