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Revocable Encroachment Permit Application

  1. 26379 Fremont Road
    Los Altos Hills, CA 94022
    Phone: 650-941-7222
    Fax: 650-941-3160

    ***The application form must be submitted with a signature, along with the General Conditions and the Traffic Control Standards . Both documents can be found below. The application will NOT be considered without the above documents attached****

  2. Plans Submitted

  3. Is the applicant the owner of the project address property?*

  4. This number is required for any excavation in a Public Right of Way or Private Easement. For further information, contact the USA Regional Notification Center at 1-800-642-2444 at least two working days prior to proposed start of excavation.

  5. The work authorized by this permit shall be subject to all terms, conditions, and restrictions set forth herein. This permit consist of this page and the General / Special Conditions attached and made a part hereof and any drawing referenced above. The project, as specifically described, is to be strictly construed and on other activity shall be permitted. Any work performed that is not part of the permit shall be promptly removed at the expense of the Permittee. The Permittee and / or his, her or its contractor shall indemnify and save harmless the Town, its officers, agents, employees, and servants from all claims, suits, or actions of every name, kind, and description, brought for, or on account of, injuries to or death of any person or damage to property resulting from the performance of the work authorized or required, or the equipment or item constructed by this Permit or Permittee and / or his, her, or its contractor, their officers, agents, employees, and / or servants.

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