APPLICATION FOR
LAKEBED ENCROACHMENT PERMIT
Assessor’s Parcel No.: _____________________ Date: _______ /_______ / 2018
Site Address: __________________________________ City: _______________________________
State: _____ Zip Code: _____________ E-mail ________________________________________
Property Owner: _____________________ Phone Number: ________________________________
Mailing Address _______________________________ City: __________________________________
State: ________ Zip Code: ____________ E-mail: __________________________________________
Contractor: _________________________ Phone Number: ___________________________________
Address: _____________________________________ City: __________________________________
State: ______ Zip Code: ____________ E-mail: ____________________________________________
Please provide written explanation on spaces provided below, as well as: Site Plans, Map(s) and
Payment of $813.00 (check or money order only) upon submission of Encroachment Permit
Application***
Project Description:__________________________________________________________________
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Additional Information/ Notes: ________________________________________________________
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WATER RESOURCES DEPARTMENT
255 N. Forbes Street
Lakeport, California 95453
Telephone: 707-263-2344
Fax: 707-263-1965
W:\Lakebed\Encroachments\Encroachment Permit Documents\Lakebed Encroachment Permit Application 2018
