Temporary Roadblock Permit Application Form
Apply for authorization to implement a temporary roadblock. Please provide all required details to ensure prompt review and processing.
Applicant Full Name
*
First Name
Last Name
Organization or Company Name (if applicable)
Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Roadblock Location (Street, Cross Streets, or Area)
*
Start Date and Time of Roadblock
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
End Date and Time of Roadblock
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Reason for Roadblock (e.g., construction, event, maintenance)
*
Please Select
Construction
Public Event
Maintenance/Repair
Utility Work
Other
Description of Roadblock Activities and Impact
*
Upload Map or Traffic Management Plan (if available)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Estimated Number of Personnel On-site
Emergency Contact Name and Number During Roadblock
*
Have you notified affected residents or businesses?
*
Yes
No
Submit Application
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