Date of Closing: _______________ Hours: _______________
Street: _____________________________________________
From: _____________________ To: _____________________
(Cross Street) (Cross Street)
Type of Event and Activities: _____________________________
___________________________________________________
Date of Filing of Petition: ________________________________
Petitioners' Street Closing Agent: _________________________
(Please Print)
Address and Zip Code: ________________________________
Daytime Phone Number: _______________________________
TO BE READ BEFORE SIGNING PETITION: Before signing this petition I have read a copy of "Requirements for Approval of Street Closing Petition and Conditions Which Apply Upon Acceptance of Petition", I understand that all the requirements and conditions in that document are incorporated by reference into this petition. My signature constitutes my personal approval, acceptance, authorization, liability, and compliance with all those requirements and conditions.
Signature: Address:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Fax the form and petition to CDOT at 704-336-4400 or mail to:
CDOT
Public Service & Communications Division
600 East Fourth Street
Charlotte, NC 28202
