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INSTRUCTIONS FOR COMPLETING AN ENCROACHMENT AND JOINT USE AGREEMENT

OF A RIGHT-OF-WAY

All forms shall be signed in ink only by a property owner, legal partner or corporate officer. An authorized agent of

the landowner must submit a Power of Attorney.

submit copies of signatures and notary acknowledgments.

3. One copy of EXHIBIT NO. 1 that contains the precise metes and bounds description of the part of the right-of-

way to be used. This information is best provided by a registered land surveyor. Note that the City staff is

not authorized to prepare this information. Do not place drawings or plats on this exhibit.

4. One copy of EXHIBIT NO. 2 which shows in graphic form the nature of the encroachment with dimensions.

Please limit the area of usage of the right-of-way to only that needed to accommodate your needs. Plans or

drawings may be reduced, provided the final document is legible. City staff will make final decision on

legibility.

have utility equipment in the easement. This will need to be done before submitting to the City of Southlake.

7. After this agreement is filled out, you will need to return it to Public Works Department and pay:

• The ROW Encroachment Permit Fee of $255.

8. This agreement will be circulated through the Planning and Development, Building Inspection and Public

Works Departments within the City of Southlake. Please allow approximately seven to ten working days to

complete the circulation process.

9. Then the agreement will be placed on a City Council Agenda for Council review and approval. Council

Submit these documents to:

City of Southlake

Department of Public Works

1400 Main Street, Suite 320

Southlake, TX 76092

APPLICATION FOR ENCROACHMENT AND JOINT USE AGREEMENT

OF A RIGHT-OF-WAY

or abutting property located at ______________________________________, and described by metes and

bounds in Exhibit No. 1 of the attached agreement.

The reason for the encroachment and use of the right-of-way is as follows:

__________________________________________________________________________________________

____________________________________ __________________________

____________________________________

Address

____________________________________

City State Zip

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COUNTY OF _________ §

No. 2 and consented to by the public utility companies as listed on the attached EXHIBIT No. 3, to be used for the

purposes of ________________________________________________________________

_____________________________________________________ and being subject to the following conditions:

That the Applicant, his successors or assigns shall maintain in good condition all of the right-of-way area and the

improvements situated thereon; and, that City and Utilities shall not become responsible for such maintenance at

That the Applicant shall and does hereby agree to indemnify and hold harmless the City and the Utilities from any

and all damages, loss or liability of any kind whatsoever by reason of injury to property or third person occasioned

by its use of the right-of-way or act of omission, neglect or wrong doing of Applicant, his officers, agents,

and the Applicant shall, at his own cost and expense, defend and protect City and Utilities against any and all

such claims and demands.

That the Applicant shall arrange for all activities and improvements in the right-of-way to be discontinued and / or

removed within thirty (30) days of written notification, at the discretion of City, for:

(1) Lack of maintenance to the right-of-way;

(2) Failure to provide access to the City or its designees; or

That the Applicant, his successors or assigns shall not seek compensation from City or Utilities for loss of the

value of the improvements made hereunder when such improvements are required to be removed by Applicant.

This agreement shall be filed of record in the Deed Records of Tarrant County, Texas, and shall bind all future

______________________________ City of Southlake

Printed Name

By: _________________________ By: ___________________________

Applicant’s Signature Mayor

NOTE: Complete the attached acknowledgements.

BEFORE ME, the undersigned authority, A Notary Public in and for the State of Texas, on this day personally

subscribed to the foregoing instrument and acknowledged to me that same was the act of said

_________________________, a corporation, and that he executed same for the purposes and consideration

therein expressed and in the capacity therein stated.

GIVEN UNDER MY HAND AND SEAL OF OFFICE this the ______ day of ________, 20________.

____________________________________

Notary Public in and for the State of Texas

The undersigned public utility companies, using or entitled to use, under the terms and provisions of our

respective franchise with the City of Southlake, do hereby consent to the encroachment and joint use of the

described portion of right-of-way requested in this Application for encroachment and joint use of a right-of-way.

Oncor Electric Delivery Company AT&T / Southwestern Bell Telephone Company

Title: ___________________________ Title: _____________________________

Verizon Telephone Company Tri-County Electric Company

By: ____________________________ By: ______________________________

(Please Print) (Please Print)

Title: ___________________________ Title: _____________________________

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By: ____________________________ By: ______________________________

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Title: ___________________________ Title: _____________________________

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Signature: ________________________ Signature: __________________________

Title: ___________________________

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Signature: ________________________