G:\Zoning 2009\Forms and documents\Website Documents\Planning & Zoning\Forms Modified: 7.24.2019
City of Pompano Beach
Department of Development Services
Planning & Zoning Division
100 W. Atlantic Blvd Pompano Beach, FL 33060 Easement Agreement
Phone: 954.786.4679 Fax: 954.786.4666
EASEMENT AGREEMENTS REQUIRED FROM:
• City of Pompano Beach Utilities Department OR Broward County WWS (Please refer to the Utility Service Areas
Map to determine if Broward County is your water and sewer provider.) • AT&T • Comcast • FP&L • Teco Peoples
Gas
TYPE OF EASEMENT (select one): [ ] Utility Easement [ ] Drainage Easement (ONLY requires approval
from the City of Pompano Beach Utilities Department.)
To Whom It May Concern: I propose to apply for a city permit to install a___________________________
in the easement on my property at______________________________________________________________.
Legal Description:
Subdivision: _________________________________________________, Block: ________ Lot: ________.
Provide a brief description of the proposed construction and state the distance to the property lines. Please send each utility company
a survey of the subject property and a sketch of the proposed construction.______________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
In the event that you have no objections to this project, please complete the form and return to:
(Applicant’s Street Address or Box Number.): ________________________________________________
(Applicant’s Address City/ State / Zip): ________________________________________________
(Phone Number): ________________________________________________
_______________________________ _______________________________________________________
(Fax) (Email)
This provision may be terminated by the City at any time for any reasonable cause, such cause to be in the sole determination of the
City, upon giving thirty (30) days’ written notice to the Owner by U.S. mail or posting of such notice on the property. Upon
termination, Owner agrees to remove at its sole expense all encroachments lying in, along and under the Easement Area.
I understand that your company will not be responsible in any way for repairs to, or replacement of, any portion of this construction
and that any removal or replacement of this construction necessary for your use of this easement will be done at my expense.
________________________________ _________________________________
(Print Name) (Owner’s Signature)
TO BE COMPLETED BY UTILITY COMPANY
We agree to the proposed construction under the circumstances described above.
Utility Provider: ______________________________________
Name and Signature: ______________________________________
Title: ______________________________________
Date: ______________________________________
NOTES: __________________________________________________________________________________
_________________________________________________________________________________________
