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Illumination:  FORMCHECKBOX  Yes  FORMCHECKBOX  NoDate Existing Encroachment Erected: FORMTEXT      Telephone No.: (include Area Code)  FORMTEXT      On Project:  FORMCHECKBOX  Yes  FORMCHECKBOX  NoControl No.:  FORMTEXT       FORMCHECKBOX  Lt.Height Above Sidewalk to Bottom of Encroachment:  FORMTEXT      Width of Sidewalk from Back of Curb to Property Line or Building:  FORMTEXT      Project No.:  FORMTEXT      If Sign,8:rt   $ ˽~r^~rK<h|h|@CJOJQJ%jh|h|@CJOJQJU'jh|h$CJOJQJUh|CJOJQJaJh|h|CJOJQJ&jh|CJOJQJUmHnHu'jh|h$CJOJQJUh|CJOJQJjh|CJOJQJUh|CJOJQJhP4 h4-CJ$hP4 h4-h|CJOJQJaJh4-h4-CJOJQJaJ:t  6 $$If^a$gd|$If^gd| $IfgdP4 $<$Ifa$4SnS$ & ( 2 4 6 8 : b d h j l ֽ֮~tc~U~tD~U~t!jh$CJOJQJUjh$CJOJQJU!jh$CJOJQJUh$CJOJQJjh$CJOJQJUh$CJOJQJ h$CJh$CJOJQJh$h|h|h|@CJOJQJ0jh|h|@CJOJQJUmHnHu%jh|h|@CJOJQJU+jh|h$@CJOJQJU6 8 : d b\R $If^$Ifkdn$$Ifl4\ +  0+4 laf4d f h  v  !$If$Ifvkd]$$Ifl480+ 0+4 laf4    , . 0 2 > @ T V X b d f h ຩȘw`VE!j<h$CJOJQJUh$CJOJQJ,jh$56CJOJQJUmHnHu'j h$56CJOJQJUh$56CJOJQJ!jh$56CJOJQJU!jh$CJOJQJUh$CJOJQJh$h$CJOJQJjh$CJOJQJUjh$CJOJQJU!jh$CJOJQJU f b\R $If$Ifkdv$$Ifl4\D#+ \0+4 laf4f h |oi$If $$If^a$ $If^vkd$$Ifl40+ 0+4 laf4      ( * , < > R T V ` b d f x      @ B ԵԤƙԈwijh$CJOJQJU!jR h$CJOJQJU!j) h$CJOJQJUh$6CJOJQJ!j h$CJOJQJU!jh$CJOJQJUh$CJOJQJh$h$CJOJQJjh$CJOJQJU&jh$CJOJQJUmHnHu)  , < d nh\O\O $$If^a$ $If^$Ifkd$$Ifl40+`   0+4 laf4pd f ui\RR $If^ $$If^a$ $If^kdv $$Ifl4F + `v `v 0+    4 laf4  @ uk_RDR_<$If^ $$If^a$ $If^ $If^kd $$Ifl4F +`   0+    4 laf4B ^ ` d f j        " $ 8 q]Yh$&jh$CJOJQJUmHnHu!j h$CJOJQJUh$CJOJQJjh$CJOJQJUh$CJOJQJ!j" h$CJOJQJU!j h$CJOJQJU!j: h$CJOJQJUjh$CJOJQJU!j h$CJOJQJUh$CJOJQJ   " J X XL?L?L $$If^a$ $If^kd $$Ifl4\$+ `` `0+4 laf4 $If^8 : < F H J X Z n p r | ~  ¸§¸–’siXs!jh$CJOJQJUh$CJOJQJjh$CJOJQJU!jXh$CJOJQJUh$!jh$CJOJQJU!j\h$CJOJQJUh$CJOJQJh$CJOJQJ&jh$CJOJQJUmHnHujh$CJOJQJU!jh$CJOJQJU" $If^ $$If^a$ <222 $If^kdH$$Ifl4ֈ@ h$+` `(`8 8 8 80+4 laf4 *F  d`$If^ $If]<$If]^$If]^ $$If^a$ $If^ &(*FHdfjpt  ,TVjޤuqfXNh$CJOJQJjh$CJOJQJUh$6CJOJQJh$&jh$CJOJQJUmHnHu!j(h$CJOJQJUh$CJOJQJjh$CJOJQJU!jh$CJOJQJU!j@h$CJOJQJUh$CJOJQJh$CJOJQJjh$CJOJQJUh$CJOJQJ kd$$Ifl4ִ@ h(#Z'+ 8 8 8`X`220+    4 laf4T|,.Z\^`$If]^ $If^ $$If^a$ $If^ jlnxz|(*.0LNRX`¸~tcªR!jh$CJOJQJU!jch$CJOJQJUh$CJOJQJ!jh$CJOJQJU!j{h$CJOJQJUh$CJOJQJjh$CJOJQJUh$CJOJQJh$CJOJQJ&jh$CJOJQJUmHnHujh$CJOJQJU!jh$CJOJQJU`bkdM$$Ifl4ִP h(#Z'+` ``8 8X X X X0+    4 laf4bdfh:vd`$If^gdL$$If^a$d`$If^ $If^ `hvxL2L4LHLڤ{g\ZUh$6CJOJQJ&jh$CJOJQJUmHnHu!j}h$CJOJQJUh$CJOJQJjh$CJOJQJU!j.h$CJOJQJU&jh$CJOJQJUmHnHu!jh$CJOJQJUh$CJOJQJjh$CJOJQJUh$CJOJQJh$#OC6, $If^ $$If^a$ $If^kd$$Ifl4rP h + X X X`v `v 0+4 laf4kkd$$Ifl4F +`   0+    4 laf4 $If^2LZLLui_Y$If $If^ $If^kd$$Ifl4F +   0+    4 laf4 Advertising Copy Reads:  FORMTEXT      SIZE OF ENCROACHMENTWidth:  FORMTEXT      Length:  FORMTEXT      Height:  FORMTEXT       Sketch of Encroachment: (The sketch is to be a side view that includes dimensions that indicate how much the encroachment extends into the right of way): Affix Photo Here of Encroachment Location:  I certify all information provided above is true and accurate.District Comments:I assign the right to the State of Nebraska Department of Roads to act as my agent to remove the above encroachment if I, the owner, have failed to remove the encroachment after the 10-day written notification. If there is a change in ownership of encroachment, new owner agrees to permit stipulations or removes encroachment.  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