OAKLAND POLICE DEPARTMENT
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
box.
Address Contact No. Signature Yes No
