Street Closure Request Form

Purpose: This form serves as an official application to temporarily close a public street for construction, a public event, or in response to an emergency. It must be submitted to and approved by the appropriate municipal department prior to any closure.

Applicant Information

Name: {applicantName}

Organization (if applicable): {organization}

Phone: {phone}

Email: {email}

Address: {address}

Closure Details

Type of Closure: {closureType}

Reason for Closure: {reason}

Street(s) to be Closed: {streets}

Closure Start Date: {startDate}

Closure End Date: {endDate}

Time of Day (if partial): {closureTime}

Event or Project Details

{#isEvent}

Event Name: {eventName}

Expected Attendance: {attendance}

Event Description: {eventDescription}

{/isEvent}

{#isConstruction}

Construction Project Name: {projectName}

Permit Number: {permitNumber}

Contractor Name: {contractorName}

{/isConstruction}

Traffic and Safety

Traffic Control Plan Submitted: {trafficPlanSubmitted}

Will Detour Routes Be Clearly Marked? {detourMarked}

Emergency Services Notified: {emergencyServicesNotified}

{#detourList}

• {location}: Detour via {detourPath}

{/detourList}

Additional Documents

{#additionalDocuments}

• {fileName}

{/additionalDocuments}

Authorized Person

Full Name: {authorizedPerson}

Position/Title: {position}

Signature: ____________________________

Date: {submissionDate}

Approval Status

Status: {approvalStatus}

{#isApproved}

This application has been approved.

Approved By: {approvedBy}

Approval Date: {approvalDate}

{/isApproved}

{^isApproved}

This application has NOT been approved.