Encroachment Permit

Name of Applicant (Individual/Owner)*

First Last

Phone*

Email*

Property Address*

Street Address Address Line 2 City State ZIP Code

Requested Start Date*

Requested Start Time*

: HH

MM

Requested End Date*

Requested End Time*

: HH

MM

Name of Contractor (If Applicable)

First Last

Contractor Address (If Applicable)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contractor State License Number (If Applicable)

Location of Encroachment

Reason for Encroachment

Type of Vehicle(s) accessing District Property or Right of Way

Has work commenced or encroachment occurred prior to receiving permit?

Yes
No

Encroachment, for the purposes of this permit application, shall be defined as; Access onto District property or easement by any person except District personnel or their authorized agent for a purpose other than its intended or permitted use. Examples of activities which may require an encroachment permit include, but are not limited to, installing a pool, addition, fencing, driveways, erosion control, landscaping, planting or modifying vegetation, mowing, grading, excavations, etc. Applicant is responsible for any damages to sidewalk, street, utilities, landscaping, trees, or any other District property affected by this permit. This permit DOES NOT replace any fees or permits that may be required by El Dorado County Department of Transportation or any other agency. Applicant is encouraged to contact the DOT at (530) 621-5900 for additional information. Indemnification - Applicant , jointly and severally, for itself, its successors, agents, contractors and employees, agrees to indemnify, defend and hold harmless District, its officers, employees and agents and any successors to District’s interest from and against any and all claims, demands, losses, damages, liabilities, fines, penalties, charges, administrative and judicial proceedings and orders, judgments, remedial actions of any kind, and all costs and cleanup actions of any kind, all costs and expenses incurred in connection therewith, including, without limitation, reasonable attorneys’ fees and costs of defense (collective, the “Losses”) arising directly or indirectly, in whole or in part, out of the activities of Applicant described in this encroachment permit application.

Encroachment Permit Application