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2. Ashland Municipal Code (AMC) Chapter 13.02.040 states that no person may occupy or encroach upon a public right-of-way without permission of the City in the form of a franchise, license or permit. The City Manager has authorized the Public Works Administration Department to issue Street Painting Permits on the City’s behalf.

   Fee: $19.00

4. Applicant’s Name*
6. Mailing Address*
8. Phone Number*
10. Applicant Email*
14. Block (between X & Y Streets)
16. Closure:
    Closure: Start Date

    Closure: Start Time

    —

    Closure: End Date

    Closure: End Time
18. Purpose*
20. I certify by selecting the following is true and/or provided:

    1. All information on this application form is true.
    2. Site Plan is attached showing cross streets and areas of closure.
    3. All affected neighbors have been notified and required petition signatures have been obtain and approved by Public Works Director.
    4. All affected neighbors have been notified and required petition signatures have been attached.
    5. Only MUTCD approved barricades and road closure signs will be used.
    6. All trash will be picked up by the end of the closure time.
    7. A 20-foot emergency access lane will be maintained at all times during the painting process.
22. Map of proposed area*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field