Event Encroachment Permit

Event Encroachment Permit

County of Marin Department of Public Works
Please note – This permit allows for the use of the Public right-of-way for the event.
Name of Applicant

First NameLast Name
Address of Applicant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person's Name

First NameLast Name
Contact Person's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact Person's Email
example@example.com
Is the Contact Person's address different from the Applicant's address?
Address of Contact Person

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Information

Date(s) of Event

Rows	Time	Date
Start
End

Type of Event:

Other
Event Information, Route(s), Location(s)
Plain text only, no HTML
Please Submit a Detailed Site Map and/or Route Map showing Staging Areas, Signage,etc.

Allowable file types: pdf, doc, docx, txt, jpg, jpeg, png, gif
Cancelof
Will the number of participants exceed 100?
Number of anticipated participants
If yes, please complete the Agency Approval Form and email to Encroachment Permits Processing.
Do you require a Road Closure?
Describe Area for Parking (if applicable)
Attach your current certificate of liability insurance

Allowable file types: pdf, doc, docx, txt
Cancelof
Acceptance by Applicant
The applicant agrees to reimburse the County of Marin for any costs it may incur in connection with the applicant's event activities, including but not limited to costs for clean-up or traffic regulation, or damage to the County right-of-way. The above-stated applicant hereby agrees to protect, hold harmless and indemnify the County of Marin, its officers, agents and employees for any and all claims, liabilities or causes of action, including claims for injuries or death to persons, or damage to persons or property arising out of or inconnection with the activity permitted herein.
Acknowledgement: My electronic signature agreeing to the aforementioned is below:
Signature
Signature Date

MonthDayYear
Should be Empty:

Event Information