Encroachment Petition
TF-696-3 (Jul 10)
Name of Person/Organization Circulating Petition
Address of Person/Organization Circulating Petition
I / My organization request your approval to encroach upon the block(s) of:
Day of Encroachment Date of Encroachment Start Time End Time
As required by the Oakland Police Department, I agree to install street barricades for the event, to clean the area
after the event, to reimburse the City for any expenses that may have incurred as a result of the event, and to
comply with any other conditions that are set forth in the permit to hold this event. I agree to take this Petition to
each resident on the target block or give reason why resident was not contacted.
_________________________________________________ ______________
Signature of Person Circulating the Petition Date
Resident/Business Representative: Please indicate whether you/your business approve (yes) or disapprove (no)
of the proposed encroachment. Please sign below, include your telephone number and check the appropriate
Address Contact No. Signature Yes No
Address Contact No. Signature Yes No