Gonzales will continue to be a safe, clean, family-friendly community, diverse in heritage, and committed to working collaboratively to preserve and retain its small-town charm PO Box 647 147 4th Street. Gonzales, CA 93926
(831) 675-5000 www.gonzalesca.gov
NEW ENCROACHMENT PERMIT
APPLICATION
Property Owner
Name:
Cell and Home Phone:
Mailing address:
E-Mail address:
Contractor (must have appropriate license(s) with the Contractor License Board and have a city business license)
Name:
Business Name:
Cell and Business Phone:
Mailing address:
E-Mail address:
License Number and Class:
Project Information
Address:
Start Date/Time: Completion Date/Time:
Type of Work
Description of all work including related on-site construction (Attach Plans or Sketch of work in the public right-of-way) New Driveway Approach
Street Improvements
Sidewalk
Water/Sewer Connection
Dry Utilities
Street/Sidewalk Closure?
Other
Check All Items That Apply to Your Project
Closing Street/Crosswalk requires a Traffic Control Plan (TCP). TCP’s must comply with the Work Area Traffic Control Handbook or part 6 of the California Manual of Traffic Control Devices Closing Sidewalk Digging in the Street Trenching 5 feet or deeper
CITY USE ONLY
Permit No:
Daily fee = $139.10
APPLICANT DECLARATION
In addition to the "Encroachment Permit General Provisions", all permittees must comply with the following requirements:
1) Permittee shall call USA Alert at 811 or (800) 642-2444 at least two working days before any excavation.
2) Permittee shall repair disturbed or damaged streets, curb and gutter, access ramps, and/or other improvements within the public right-of-way in accordance with City Construction Standards.
3) Permittee must request an inspection by city public works staff by calling (831) 675-5000 prior to beginning the work, after forms are set for all concrete work and upon completion of the work.
4) Permittee shall have a copy of the approved Traffic Control Plan (if applicable) on site. 5) Permittee shall notify the following city offices prior to any street closure:
a) Public Works Department at (831) 675-5000
b) Fire Department at (831) 675-4204
c) Police Department at (831) 675-5010
6) For street/pedestrian closures, permittee shall maintain one-way traffic unless detour signs are installed 72 hours in advance. The applicant agrees that the work will be done in accordance with City Standards and Specifications and is subject to this permit's terms and conditions, the State Streets and Highways Code and all work is subject to inspection.
I received a copy of the "Encroachment Permit General Provisions" and understand them
PERMITTEE SIGNATURE PERMITEE PRNTED NAME DATE
CITY USE ONLY
Public Works Supervisor: DATE:
Public Works Director: DATE:
Final Inspection by: DATE: