APPLICATION FOR HANDICAPPED PARKING SPACE

Daniel Horrigan Mayor

John O. Moore Service Director

DEPARTMENT OF PUBLIC SAFETY / SERVICE DIVISION OF TRAFFIC ENGINEERING 1420 Triplett Boulevard Akron, Ohio 44306-3390 Telephone: (330) 375-2851 FAX: (330) 375-2307

David J. Gasper, P.E. Traffic Engineer

Paint & Sign Shop Parking Meters Traffic Signals

APPLICATION FOR HANDICAPPED PARKING SPACE

NAME: _________________________________________________________________________ ADDRESS: ______________________________________________________________________ DAYTIME PHONE: _________________________ EMAIL: ________________________________ OHIO DRIVER'S LICENSE NUMBER: _________________________________________________ YEAR AND MAKE OF VEHICLE: _____________________________________________________ VEHICLE'S LICENSE PLATE NUMBER: _______________________________________________ TYPE OF DISABILITY WHICH LIMITS THE DISTANCE YOU CAN WALK: ____________________ ________________________________________________________________________________ ARE A.D.A ACCESSIBLE FACILITIES PRESENT? (i.e. HANDICAPPED RAMP): _______________ ARE OFF-STREET PARKING SPACES AVAILABLE AT THIS ADDRESS? (i.e. GARAGES, PARKING PADS, OR A DRIVEWAY): __________________________________________________________ IF YES, PLEASE DESCRIBE WHY THESE SPACES CANNOT ACCOMMODATE YOUR NEEDS: ________________________________________________________________________________ ________________________________________________________________________________ ARE YOU THE HOMEOWNER OR A RENTER: _____________ (* * * RENTERS MUST INCLUDE WRITTEN PERMISSION FROM THEIR LANDLORD FOR THE SIGNS TO BE INSTALLED). NUMBER OF TIMES YOU LEAVE THE HOUSE WEEKLY: _________________________________

I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS CORRECT. I UNDERSTAND THAT THE PARKING SPACE MAY BE REMOVED WHEN THE DISABLED PLACARD OR PLATE EXPIRES. I UNDERSTAND THAT APPROVAL OF THIS APPLICATION IS SUBJECT TO REVIEW. I ALSO UNDERSTAND THAT THE SPACE IS NOT EXCLUSIVELY MY OWN. ANY VEHICLE WITH A VALID HANDICAPPED PLACARD MAY PARK IN THIS SPACE.

SIGNATURE: _____________________________________ DATE: ________________________

PLEASE MAIL THIS APPLICATION, ALONG WITH A PHOTOCOPY OF YOUR HANDICAPPED PLACARD AND A LETTER FROM THE PROPERTY OWNER (IF APPLICABLE) TO:

CITY OF AKRON, TRAFFIC ENGINEERING 1420 TRIPLETT BLVD, BLDG 2 AKRON, OH 44306

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