Fillable DEVELOPMENT SERVICES DEPARTMENT EASEMENT ENCROACHMENT FORM (Lake Havasu City)

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DEVELOPMENT SERVICES DEPARTMENT EASEMENT ENCROACHMENT FORM (Lake Havasu City)

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Easement Encroachment Form Rev 04/17/2020
LAKE HAVASU CITY
DEVELOPMENT SERVICES DEPARTMENT
2330 MCCULLOCH BLVD N ♦ LAKE HAVASU CITY, AZ 86403
www.lhcaz.gov ♦ 928.453.4148
EASEMENT ENCROACHMENT FORM
Applicant: ______________________________________ Phone:_________________________
Email: _________________________________________ Fax: ___________________________
Location: Tract _____ Block _____ Lot _____ Site Address: ____________________________ __
A request to: (Check & complete appropriate action)
Construct __________ linear feet of retaining wall in an easement.
Construct __________ linear feet of freestanding wall in an easement.
Cut/Fill ____________ cubic yards of soil (dirt) in an easement. (No prior Building Division approval necessary)
Other ___________________________________________________ in a public utility easement.
A location map/site plan showing the proposed improvements must be provided with this application.
Comments: _______________________________________________________________________
________________________________________________________________________________
Call 811 or visit www.arizona811.com to have the utilities marked prior to contacting the utility companies
Utility Contact Information
LHC
BUILDING DIVISION
2330 MCCULLOCH BLVD N
PHONE (928) 453-4148
buildingpermits@lhcaz.gov
UNISOURCE
ELECTRIC
2749 MARICOPA AVE
PHONE (928) 505-7017
FAX (928) 453-6773
clangford@uesaz.com
UNISOURCE
GAS
6405 Wilkinson Dr
Prescott, AZ 86301
PHONE (928) 226-2245
FAX (928) 717-1794
druffalo@uesaz.com
FRONTIER
COMMUNICATIONS
1021 N LAKE HAVASU AVE
#104
PHONE (928) 757-0218
FAX (928) 681-2349
james.hansen@ftr.com
SUDDENLINK
COMMUNICATIONS
1049 Hancock Rd
Bullhead City, AZ
PHONE (928)219-4965
pete.howard@alticetech
servicesusa.com
THIS PORTION TO BE COMPLETED BY LHC BUILDING OR UTILITY COMPANIES ONLY
Date Approved
Date Denied
Signature of Reviewer
Date Responded
LHC BUILDING
____________
__________
________________
_________
Unisource Electric
____________
__________
________________
_________
Unisource Gas
____________
__________
________________
_________
Frontier
____________
__________
________________
_________
Suddenlink
____________
__________
________________
_________
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DEVELOPMENT SERVICES DEPARTMENT EASEMENT ENCROACHMENT FORM (Lake Havasu City)

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Completed 3 August 2020

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