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CERTIFICATE OF ENCROACHMENT APPLICATION - Private Entrance

2. Name*

4. Address

6. City

7. State

8. Zip Code

10. Phone Number

11. Email Address

13. Address of Proposed Encroachment*

14. Encroachment is on:

    1. County Road
    2. State Road

16. Description of Specific Location*

    Please describe site of encroachment, including name of street, what side of street (North, South, East or West), and approximately how many feet in which cardinal direction from the closest landmark.

18. Additional Information

Leave This Blank:


21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field