Temporary Closure
Street/Public Parking Spaces/Sidewalk
Applicant Name/Title:
Company: Email:
Mailing Address:
Phone (check preferred method): Office: Mobile:
Street/Sidewalk/Public Parking Area to be Closed:
Number of Parking Spaces to be Closed:
Date(s) and Time(s) of Closure:
Reason for Closure:
Block Party
• Applicant must be a resident of the street to be blocked.
• Public way to be blocked with items that are easily removable (saw horses, cones) to allow
Police & Fire entry, if needed.
• One lane must remain open at all times for emergency vehicles.
• If sound amplification is to be used, a Sound Application must be approved by the Police
Department.
Dumpster Construction Event Other:
1. Please provide the following information:
• A sketch indicating the street(s)/sidewalk(s)/parking area(s) to be impacted, including the
specific street address(es) of dumpster location. The sketch should show the following: city
streets around the job site, the job site, sidewalks and public parking spaces affected (if any), the
direction of travel lanes (use arrows), and the temporary traffic control measures to be used to
safely channel/detour traffic.
• Detour plan (if needed).
• Certificate of Liability Insurance naming the City of Lebanon as an additional insured.
2. In the event any object(s), including, without limitation, any equipment, vehicles, temporary
scaffolding, trailers, containers, etc., are to be located within the right-of-way during the period of
your temporary use, the presence of any and all such object(s) must be specifically authorized in
writing and included on the aforementioned sketch. The City reserves the right, prior to approval of
any additional or other objects in the future, to require additional insurance coverage from you.
3. Should you fail, at any time, to comply with any of the conditions stated above, the City may revoke
your permission to use the right-of-way and require you to immediately cease activities and remove
all objects and equipment.
Ac
knowledged:
Applicant Signature Date
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CITY USE ONLY:
Po
lice Dept. Review/Approval: Date:
Fire Dept. Review/Approval: Date:
Public Works Dept. Review/Approval: Date:
City Manager
Application must be received at a minimum seven (7) business days in advance of closure.
