HPD-013 (Rev. 07-19) Pg. 1 of 2
Street Address Signature Printed Name
Return completed form to: Hilliard Division of Police, Attn: Street Closure Permits, 5171 Northwest Parkway, Hilliard, Ohio 43026 or email to
hilliardpolice@hilliardohio.gov. Call (614) 334-2140 with questions.
For Administrative Use Only
Approved:
Permit Sent To Applicant By: Email Mail Pick Up on Date:
Date Permit Emailed
to Service Dept:
Denied: Reason: Applicant Notified by: Email Mail on Date:
Contact Name:
Permit #
Address:
City:
Zip:
Cell Phone:
Home Phone:
Email:
Street/Subdivision/Organization Hosting the Closure:
Date of Street Closure:
Time Street Will Be Blocked
From:
To:
The City of Hilliard Public Service Department will drop off barricades and cones on the side of the street the day prior to your event. You are responsible
to move the barricades and cones into position to block the approved area at the proper time, then move the barricades and cones back to the side of the
street when the event ends. The barriers should only be in place during the approved hours of the event. The City of Hilliard PSD will pick up the
barricades and cones the day following your event.
Comments: (i.e., “Only the cul-de-sac will be blocked.” Brown Rd will be blocked between Red Dr. and Yellow Dr.”)
List below each street address that will be affected by the street closure. One adult from each affected address must sign his or her name, signifying
permission for the street closure. Use additional paper, if needed.
STREET CLOSURE APPLICATION
Hilliard Division of Police
CLEAR FORM
HPD-013 (Rev. 07-19) Pg. 2 of 2
Street Address Signature Print Name
STREET CLOSURE APPLICATION
Hilliard Division of Police
CLEAR FORM
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