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2. Date Of Application*
   Date Of Application
4. Name of Organization (If Applicable)
6. Name of Applicant*
7. Email Address (This is the e-mail address the permit will be e-mailed to*
9. Address of Residence *
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. Address*
    The location of where the obstruction will occur.
19. City*
20. State*
21. Zip Code*
23. Additional Information if needed:
25. Start and End Dates *
    Start and End Dates Start Date

    —

    Start and End Dates End Date
27. Describe the nature, materials involved, and reason for the permit.*
29. $25.00 Fee (Non-Refundable)*

    1. By clicking here, I understand the following:

    I can not dump material near storm drains or exceed eight feet wide with the obstruction. In addition, I understand I need to use safety cones or barricades around the obstruction, to remove all materials from the street with 24 hours (unless otherwise stated), and sweep the street clean after removing the obstruction. This application can take up to two (2) business days to process (sometimes longer). I understand after I click on submit, I will be taken to the on-line payment section for payment of the fee. This application can only be processed after payment is made.
31. Electronic Signature
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field