TOWN OF NORTH HEMPSTEAD
APPLICATION FOR AN EVENT USING PUBLIC ROADS
Directions:
Print this form on your printer. Answer all questions. Application must be filed 30 days prior to the date of event. It is the
responsibility of the applicant to notify all businesses and residents on the route.
NAME OF APPLICANT: Phone #
ADDRESS:
NAME OF ORGANIZATION: Phone #
ADDRESS OF ORGANIZATION:
NAME OF PERSON IN CHARGE: Phone #
ADDRESS OF PERSON IN CHARGE:
TYPE OF EVENT:
DATE OF EVENT: RAIN DATE:
STARTING TIME: TERMINATION TIME: ANTICIPATED ATTENDANCE:
NUMBER AND TYPE OF VEHICLES (if any):
TIME OF ASSEMBLY (if applicable):
HAMLET:
ASSEMBLY AREA-STREET: BETWEEN INTERSECTIONS
OF
ROUTE OF EVENT:
SIGNATURE: DATE:
For Clerk use only
Date Application Received:
Date Forwarded to Headquarters: Precinct:
Approval / Denial: Headquarters Precinct to Cover
Comments:
DATE: Clerk:
LESLIE C. GROSS, TOWN CLERK
PO Box 3000, 200 Plandome Road, Manhasset, NY 11030 516-869-7646
A FALSE STATEMENT WILL RESULT IN THE DENIAL OF THIS OR ANY FUTURE PERMIT APPLICATIONS
If barriers are required, arrangements must be made with the Highway Department Sign Shop, 285 Denton Avenue, New Hyde
Park, call Telephone #294-7918. Barriers must be picked up before 3 p.m. on the Friday before the event and returned the next
working day after the event between 8 a.m. & 3 p.m., in good condition or there will be a charge.
