OFFICE OF THE TOWN CLERK
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3025 email: email@example.com
DONALD X. CLAVIN JR.
BLOCK PARTY APPLICATION
Please Print Clearly - Answer all questions
Map Ref. #
Applicant’s Email address:
LOCATION WHERE EVENT WILL BE HELD:
4. Date of Event:
5. Time of Event:
1. Notify and obtain signatures of ALL residents who live on the street, a majority of which must approve.
2. Obtain permission of local fire district AND permission of local police precinct.
3. Supply own street barricades, safety cones or caution tape. You may contact our
Town of Hempstead’s Department of Highway at (516) 812-3471 for barricades.
4. FIREWORKS OF ANY KIND ARE PROHIBITED.
5. Bicycle riding is prohibited within the confines of the block party.
6. Application must be received in this office at least TWENTY (20) DAYS PRIOR TO BLOCK PARTY.
7. The roadway must have a lane free of obstruction, to allow emergency vehicles access to entire street.
8. Person signing this document is responsible for ensuring that the above conditions are fulfilled.
POLICE DEPT. APPROVAL
* APPLICANT GUIDELINES *
* Must end by 11pm
DATE PRECINCT #
FIRE DEPT. APPROVAL
Office Use Only
PLEASE OBTAIN POLICE AND FIRE APPROVAL SIGNATURES
PRIOR TO SUBMITTING TO THE TOWN OF HEMPSTEAD