PERMISSION TO ENTER PROPERTY

PROJECT NO. & NAME:

PROJECT LOCATION:

PROPERTY OWNER:

PARCEL:

The undersigned property owner, owner’s agent/representative, or lessee hereby grants permission to the City of Grand Junction, its contractors, agents, and all others deemed necessary by the City, to enter the

property identified above and perform the following activities:

DESCRIPTION OF WORK TO BE DONE

Perform boundary survey, including but not limited to; recovery of and measurements to horizontal and vertical survey marks; topographic survey which includes the modeling of ground terrain and the measuring and mapping of physical features; and the placement of temporary survey stakes or project control markers.

This permission to enter does not include any drilling, digging, or sampling of materials by means other than the use of hand tools. Any holes dug will be back-filled to their original condition prior to the City’s contractor and/or agents leaving the site.

Work to be completed by , who has been contracted by the City of Grand Junction to complete the work referenced above.

Conditions and/or agreement of or for entry (to be completed by property owner as needed):

PERMISSION GRANTED BY: (CHECK ONE) PROPERTY OWNER

OWNER’S REPRESENTATIVE/AGENT LESSEE

NAME (PLEASE PRINT)

SIGNATURE

DATE

HOME ADDRESS (IF LESSEE)

PHONE (  )

OWNER’S HOME ADDRESS

WORK PHONE (  )

PERMISSION RECEIVED BY:

NAME & TITLE (PLEASE PRINT)

SIGNATURE

DATE

DEPARTMENT

PHONE