City of Decatur, Illinois
Department of Public Works
APPLICATION FOR TEMPORARY
STREET / LANE CLOSURE
#1 Gary K. Anderson Plaza
Decatur, IL 62523
Phone: (217) 424-2747
Fax: (217) 424-2799
Permit – Type or Use Ink
Must be completed as directed by City of Decatur Public Works Department
APPLICANT’S NAME / ADDRESS:
DATE: __________________
PHONE NUMBER: ( ) FAX NUMBER: ( ) EMAIL ADDRESS:
CONTACT PERSON: LICENSE NUMER:
PURPOSE FOR CLOSURE:
STREET(S) INVOLVED (LIST STREET NAME(S), ADDRESS(ES), BLOCK(S), ETC.):
DURATION:
FROM (DATE) -------------------------------- AT (TIME) ----------------------------------
TO (DATE) ------------------------------------------- AT (TIME) --------------------------------
FUNCTIONAL CLASSIFICATION OF THE CLOSED ROAD / STREET(S):
IS THE ROAD / STREET TO BE COMPLETELY CLOSED? YES NO
WILL DETOUR ROUTE BE REQUIRED: YES NO
IF YES, DETOUR ROUTE WILL BE AS FOLLOWS (OR ATTACHED SEPARATE SHEET(S)): ____________________________________________
______________________________________________________________________________________________________________________________________
THE CLOSURE OF STREETS CLASSIFIED IN THE DECATUR ROADWAY SYSTEM PLAN AS SECONDARY COLLECTORS OR
GREATER WILL REQUIRE A MARKED DETOUR ROUTE UNLESS WAIVED BY THE TRAFFIC ENGINEER.
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FOLLOWING THE APPROVAL OF THIS APPLICATION, THE ENGINEERING DIVISION WILL EMAIL NOTIFICATION TO THE
MEDIA AND CITY OFFICES AND WILL EMIAL APPROVED PERMIT BACK TO CONTRACTOR
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APPROVED BY: __________________________________________________________ DATE: _________________________________
Department of Public Works
To be filled in by Public Works
DONE BY: _________________________________________________
DATE: _______________________ TIME: ______________________
