Fillable City of Moorpark Public Works Department (City of Moorpark)

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City of Moorpark Public Works Department (City of Moorpark)

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City of Moorpark
Public Works Department
799 Moorpark Avenue, Moorpark, California, 93021
(805) 517-6256
www.moorparkCA.gov
Street Sweeping Exemption Application
Name Application Date Email address
Street address Phone number
Please Note: the registered owner of the above address is allowed six (6) free permits per calendar year. Additional
permits will be issued at a cost of twenty-five dollars ($25) per vehicle. Attach additional forms as necessary.
Exemptions for street sweeping shall be allowed for the following reasons; 1) medical emergencies; 2) construction
on the home; 3) disabled vehicle; and 4) moving. In all circumstances, proof must be provided.
Below, list each vehicle make/mode/color/license number for each permit requested:
Vehicle 1 Make Model Color Vehicle License Number
Vehicle 2 Make Model Color Vehicle License Number
Vehicle 3 Make Model Color Vehicle License Number
__________________________________ _____________________
Applicant Signature Date
FOR CITY USE ONLY - ISSUE DATE:_____________
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City of Moorpark Public Works Department (City of Moorpark)

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Completed 14 July 2020

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