OAKLAND POLICE DEPARTMENT
Short Term Encroachment Permit
TF-696-2 (Aug 10)
APPLICATION (Completed by applicant)
Name of Person in Charge of Event
Contact No. (510)
Date of Birth
Address City Oakland State/Zip No. of Persons Expected
Date of Event Day of Week Time/Start – End Location (block) of Event (e.g., 100 Block of Brown St.)
/
Purpose of Event
Residential Block Party Merchant/Commercial Sidewalk Sale
Athletic Event Festival
Show / Dance
Other (Specify)
Liability Insurance (Merchant/Commercial Only) - Attach Copy
Name of Company: Policy No.:
Sponsored by (Organization’s Name)
Petition
I agree to provide street barricades, cleanup and, as required, security monitors and to pay any police overtime costs
necessary to conduct the above event. Also I agree to comply with permit conditions, if any, set forth below:
Signature of Person in Charge of Event (Required)
Date
TRAFFIC OPERATIONS SECTION USE ONLY
Previous Permit Last Six (6) Months
Yes No
Permit Conditions: (“Kiddie Jumpers” Are Not Allowed on City Streets)
Estimated Number of Police Needed Total Hours Total Costs
Application Fees Paid
Date:
Police Overtime Costs Paid
Date:
TRAFFIC COMMANDER’S RECOMMENDATION
Approved Denied
Signature Date
OFFICE OF CHIEF OF POLICE USE ONLY
A permit for the above event is hereby
Approved Denied (See Attached Letter)
Signature of Chief of Police or Designee
X___________________________________________________
Date
click to sign
signature
click to edit
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