ENCROACHMENT PERMIT
The undersigned is applying for a permit to enter in upon and use a portion of city property (city property includes, but is not limited to,
easements, rights-of-way, licenses, leased or fee land, real estate, utilities and appurtenances; hereafter referred to as “property”). Applicant
acknowledges that inspections will be performed pursuant to City of Yuma Construction Standards and the adopted building code by City of
Yuma personnel.
Owner: Address Location:
For the purpose of:
The undersigned acknowledges that they have read the conditions listed on Page 2 of this application and accept said conditions in
consideration of granting this permit or license for the purpose(s) herein set forth, and agree the right of entry is subject to terms of the
City’s interest in said property.
CONTRACTOR CONTACT
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ADDRESS EMAIL
PHONE
ROC-LIC #
Date SIGNATURE
THIS APPLICATION is approved with the following directions, requirements and specifications:
1. All work performed within City of Yuma (COY) property shall comply with COY construction standards and specifications.
2. COY Engineering Services (928.373.4520) shall be notified 48 hours in advance of all work.
3. Newly paved or overlaid streets or alleys shall not be open cut for a period of two (2) years.
4. Water/sewer taps shall only be inspected Tuesday through Thursday between 7:00 am and 3:00 pm. Contractor will not backfill until the
water or sewer lines have been inspected.
5. All other work within COY property shall be inspected Monday through Friday between 7:00 am and 3:00 pm.
6. The licensee must call: COY Engineering (928.373.4520); 3 working days
in advance if any work involves closing a street or alley to
vehicular traffic.
PERMIT & LICENSE
PERMIT #: Fee $
A permit and license is hereby issued to the foregoing licensee for the purpose contained in the application and upon the expressed
condition that every agreement and covenant therein contained is faithfully performed and said work to be performed in accordance with
approved plans and specifications, or as stipulated.
Date Issued
Construction work or use to be completed by
DATE CITY ENGINEER
(SEE PAGE 2) (12.17.14) Encroachment Permit
CITY OF YUMA
CITY ENGINEERING
APPLICATION FOR PERMIT TO USE CITY PROPERTY
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City of Yuma City Engineering (12.17.14) Encroachment Permit (Page 2)
FOR AND IN CONSIDERATION of granting a permit or license for the purpose set forth herein the Licensee
hereby agrees, covenants, and binds said Licensee as follows, to wit:
1. That the Licensee assumes the responsibility and all liability for any injury or damage to said property, or to any
person while using said property in a lawful manner, caused by or arising out of the exercise of this permit or license.
2. That all work done shall be at the sole cost and expense of the Licensee, and shall be done at such time and in such
manner as to be least inconvenient to the traveling public, and as directed by the agent of the Licensor. It is
Licensee’s responsibility to obtain prior written consent from any Lessee of the City at the time in possession of any
property included in this agreement. Work must be finished in the time specified on the permit.
3. That when the proposed work is completed the Licensee shall repair the roadbed and replace the surfacing material
thereon, and will leave said property in as good a condition as it is now, so far as the property is affected by the
Licensee.
4. If the subject of the permit of license fails to pass final inspection, the Licensee will remove or replace same within
same within such time as specified by written notice from the Licensor; or if at any time hereafter, any material used
by the Licensee in replacing or reconstructing any part of said property proves defective, the Licensee will replace
same with the kind and quality of material which the Licensor shall specify.
5. That if the title and possession of any improvements placed upon the property by the Licensee remains in said
Licensee, the Licensee shall and will promptly perform all necessary repair work upon written notice from the
Licensor, and will not permit or allow any condition to exist which would be a hazard or source of danger to the
traveling public.
6. That at any time hereafter any permit or license granted in pursuance of this application, may be revoked by the
Licensor and all rights there under terminated, and upon sufficient notice, the Licensee shall and will remove all
improvements belonging to said Licensee.
7. That in the event that work to be done under authority of the permit or license necessitates creation of any hazard or
source of danger to any person or vehicle using said property, said Licensee shall and will provide and maintain at all
times during the existence of said hazard, sufficient barriers, danger signals, lanterns, detours, and shall be and will
take such measures of precaution as the Licensor shall direct.
8. A.R.S. 28-650 requires any contractor, firm or corporation performing work on roads, streets or highways, shall post
and maintain at the work site until the work is complete or until such time as the governing body authorizes the
removal, such warning signs, signals, markers and barricades in compliance with the MANUAL ON UNIFORM
TRAFFIC CONTROL DEVICES. A traffic control plan will be approved prior to construction.
9. That the Licensee shall furnish suitable plans, maps, or diagrams showing the place, character and extent of the
proposed work as deemed necessary by the Licensor. Any changes in construction because of the change in design,
errors, field conditions other than shown on the application, or any other factors requiring construction other than
shown on the drawings will require immediate cessation of construction, and will require re-approval of this permit.
Field conditions other than shown on the drawings, as well as failure to inform the City of Yuma, Engineering
Services, of any changes may be cause for cancellation of this permit.
10. To conform with A.R.S., Chapter 2, Article 6.3, Sections 40-361.21 through 26 amended, 27, and 40-360.28 added,
the Licensee shall contact the Blue Stake Center a minimum of three (3) working days prior to the planned start of
construction.
11. Contractor shall comply with all State, Federal, and O.S.H.A. Safety, Health, and Welfare Regulations. Asbestos
Certification shall be required for all cement asbestos water main construction.