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Temporary Permit for use of Sidewalks/Streets and On-Street Parking Spaces

  1. Title II Compliance
    In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.
  2. Name of organization
  3. Applicant's Full Name
  4. Date of Birth
  5. Close Street*
    To Temporarily
  6. Are Signs Needed?
  7. Primary Street Name
  8. Street Name
  9. Street Name
  10. Type of Event
  11. MM/DD/YYYY
  12. Requirements for event:
    For street closures, a minimum of four barricades (lighted if night event) are required for each closure point. No sidewalks or curb ramps may be blocked or obstructed, unless accommodations are made in accordance with the Americans with Disabilities Act. Barricades will not be placed before the start time on the permit and will be promptly removed at the end time. Signatures will be obtained from two thirds of all residents/businesses located within the area to be enclosed. Names, addresses, phone numbers and signatures are required at the time the permit is submitted. A 10X10 space shall be designated for First Amendment groups/persons/activity (if applicable). No jumphouses or any type of play equipment shall be set up on the city street. In the event of an emergency, emergency vehicles must be able to get through the are (20 foot of clearance is needed). Evidence of insurance naming the City of Modesto as additional insured may be required. In the event of any violation of the conditions, the Modesto Police Department may revoke this permit.
  13. Acceptance*
  14. Chief of Police or Designee Signature
  15. Leave This Blank:

  16. This field is not part of the form submission.