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Requirements and Signatures

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.
MPD Permit #
This is for internal use only. Do not fill this in.
Requirements for event:
- 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.
- For street closures, a minimum of four barricades (lighted if night event) are required for each closure point. The Modesto Police Department does not provide barricades.
- 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.
- 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.
Signatures Required*
Please do not submit this Permit Application until you have a complete Street Closure Acknowledgement form with all required signatures.
1. I understand that in order to obtain this permit, two-thirds of the residents and/or businesses must sign the Street Closure Acknowledgement Form below.
Street Closure Acknowledgement Form Download
Download Street Closure Acknowledgement Form (Printable PDF)
Upload Street Closure Acknowledgement Form*
Upload your completed Street Closure Acknowledgement Form with the signatures from two thirds of the impacted residents and/or businesses.
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Permission is Hereby Granted to

Name of Person/Organization*
Permission is Hereby Granted to this individual or organization.
Street Address*
Enter the individual or organization's street address.
City*
State*
Zip Code*
Phone Number*
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Applicant Information

Applicant's Full Name*
Enter the full name of the person in charge of event.
Date of Birth*
Date of Birth
Applicant's Street Address*
City*
State*
Zip Code*
Applicant's Phone*
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Closure and Use Details

To Temporarily*
Check all that apply.
1. Close Street
2. Use Sidewalk
3. Use Parking Spaces
4. Close Ally
How many parking spaces?*
Are Signs Needed?*
1. Yes
2. No
You will need to posts signs on impacted parking spaces or street closures.
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Location Details

At Location *
Primary Street Name
Does this street closure encompass more than one block radius?*
Upload your Traffic Safety Plan*
Required if the street closure will encompass more than a one block radius.
Between*
Street Name
and*
Street Name
Between*
Street Name
and*
Street Name
For the Purpose of*
Type of Event
Approximate Number of Attendees*
How Many Days?*
Event cannot be more than 3 days.
On the Date of*
On the Date of
MM/DD/YYYY
On the Date of*
On the Date of Start Date
—
On the Date of End Date
If dates are not consecutive, you must fill out another application.
between the times of*
between the times of Start Time
—
between the times of End Time
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Acceptance and MPD Approval

Acceptance*
1. I have read and understand the conditions of this permit and agree to comply with the conditions as set forth.
Modesto Police Department Approval
Chief of Police or Designee Signature
Issuing Officer and IBM #
Municipal Code for Permits
https://library.municode.com/ca/modesto/codes/code_of_ordinances?nodeId=TIT3PUSA_CH2TRRE_ART17TEUSSISTREOREPASP

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

This field is not part of the form submission.
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Temporary Permit for use of Sidewalks/Streets and On-Street Parking Spaces

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Requirements and Signatures

Permission is Hereby Granted to

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Closure and Use Details

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