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City of Spearfish Encroachment Agreement Application

2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
9. Zip Code
11. Phone Number
12. Fax Number
14. Email Address
16. Address where encroachment is requested*
18. Will this result in a permanent use of City propety?*

    1. Yes
    2. No
19. Start Date
20. End Date
22. Please describe the proposed or existing use of city property you wish to secure with this application:*
24. Does this application involve new construction?*

    1. Yes
    2. No
25. Contractor's Name
26. Contractor's Address
27. Phone Number
29. IN ADDITION TO THIS COMPLETED APPLICATION, APPLICANT MUST PROVIDE THE FOLLOWING:
    1) $100 Application Fee - check payable to City of Spearfish.----------------------------------------------------------- 2) Scaled drawing indicating the size, location, and type of improvements within encroachment area plus overall dimensions of encroachment area.-------------------------------------------------------------------------------------- 3) Commercial property only: The City of Spearfish shall be added as an insured on the commercial liability policy for public liability and property damage with limits of $1,000,000 peroccurrence/$2,000,000 general aggregate coverage. This certificate shall be provided to the City after the encroachment agreement is approved and coverage shall remain in force for the duration of the encroachment.------------------------------- 4) If the applicant is an LLC or other corporate entity, provide a copy of the current year Annual Report on file with the South Dakota Secretary of State.
31. File Upload
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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

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