Village of Caledonia Fee: 25.00
Village Clerk
Racine County Receipt No.____________
We, the undersigned residents of the ____________________ hundred block of
_____________________________ in the Village of Caledonia, consent to the use of this
street between the hours of ________ and Sunset on ________________, 20_____, for
the purpose of ____________________________________________ and request that the
Village of Caledonia grant a Street Use Permit. We agree to abide by such conditions, as
the Village of Caledonia shall attach to the granting of the requested Street Use Permit.
We further understand that the permit will be granted for this event to last no later than
Sunset on the date specified above. We also agree to remove from the street prior to the
end of said period all barricades, equipment, vehicles and any other personal property
placed or driven on the street during the event.
We designate ________________________ as the responsible person or persons to apply
for an application for a Street Use Permit on our behalf.
_____________________________ _______________________________
Responsible Party's Signature Resident Signature
_____________________________ _______________________________
Address Resident Signature
_____________________________ _______________________________
City, State and Zip Resident Signature
_____________________________ _______________________________
Phone No. Resident Signature
_____________________________ _______________________________
Date Resident Signature
Revised: 8/18/06