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Application for Excavation/Encroachment Permit

City of Cerritos Public Works Department

Job Location

Permittee Name

Mail Address

City

ZIP Code

Email Address

Telephone No.

City Business License No.

State License No.

Owner Name

Owner Email Address

Owner Telephone No.

Owner Address

Owner City

Owner ZIP Code

Description of Work

Start Date

Est. Date of Completion

Certificate of Insurance

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Business License

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Site Plans

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Traffic Control Plans

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