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Pickens County Government

Department of Roads and Bridges

186 Prison Camp Road, Pickens, SC 29671

Telephone: 864-898-5934

Fax 864-898-5938

APPLICATION FOR ENCROACHMENT PERMIT

Applicant Name and Mailing Address:____________________________________________________________

Telephone: ___________________________________________________________________________________

Address for permit: ______________________________________Subdivision:___________________________

1. The undersigned applicant hereby applies to the Pickens County Roads and Bridges Department for a permit for

encroachment on the County right-of-way or easement as shown and described below:

2. Type of encroachment: ______Driveway, ______Fence, ______Pipe Drainage Easement,

______Other (Describe) ___________________________________________________

3. Description and details of proposed installation (attach drawings showing the encroachment on the right-of-way

or easement).

4. The undersigned applicant hereby requests the Pickens County Roads and Bridges Department to permit

encroachment on the County’s right-of-way or easement as described herein. It is expressly understood that the

encroachment shall be installed in accordance with the description and details attached hereto and made a part

hereof, including the General Provisions and Special Provisions. The applicant agrees to assume any and all liability

that may be caused by the construction, maintenance, use, moving or removing, of the physical appurtenances

contemplated herein and agrees to indemnify Pickens County from any liability incurred or injury or damage

sustained by reason of the past, present or future existence of said appurtenances.

Applicant Name: _____________________________________________Date:____________________________

(print or type name)

Applicant(s) Signature: _____________________________________________Title: ______________________

Applicant(s) Telephone number:_______________________________

______________________________________________________________________________

AREA BELOW FOR OFFICE USE ONLY:

In compliance with your request and subject to all the provisions, terms, conditions and restrictions stated in the

application and special provisions below or attached hereto, the Department approves the request.

SPECIAL PROVISIONS: ______________________________________________________________________

Approved by: __________________________________________________Date: __________________________

Title: _______________________________________

Application For Encroachment Permit Form - South Carolina Department Of Roads And Bridges Page 2