APPLICATION TO USE THE PUBLIC RIGHT OF WAY
APPLICANT INFORMATION ftOM"^ i^^^
LEGAL, NAME OF ENTITY: PERMIT MAILING ADDRESS:
CITY C°M \ C f\ <^D statf. -T. L ZIP CODE: VP
City of Chicago Department of Business ' AtTiirs and Licensing Public Way Use Unit 333 S. State Street, Suite 310 Chicago, IL 60604-3977 Stan Adams (312)747-9035
Lisa Pusateri (312)747-9034
FAX
(312)745-2958
CONTACTPERSOn'T^AUA^ L r ft/Ul?T/MtYTLE ^Pj?F^S.l P)gH/T" PHONEr? 7* -ff7 C-7\*> ffPAX: -
EMAIL:
USE OF THE PUBLIC WAY
1. List the proposed or existing use below and complete the attached worksheet Only use one application per public way use type.
-Type_
How many?
Bnildinp Address
2. Please enclose one sketch of proposed use of the public way, which maps to scale
the proposed use and its relationship to surrounding right-of-way. AH measurements must be indicated.
The prints should also accurately depict the location of the property line and public facilities ( meters, light poles, sidewalks).
3. Please provide a full sized 80 Acre map, with the adjacent property and portion of the public way clearly outlined.
The 80 Acre is available at Maps and Plat in Room 905 City Hall w/$5.00 fee. APPLICANT CERTIFICATION:
I hereby certify that all statements made as part of the application and the attachments herein, and true to the best of huowlejrjge and belief.
Title: fgtg5\tse>UT-
Social Security Number: 3 C " H 3 | 1 C0 [_
ALDERMAN'S APPROVAL:
As part of this application process, you are required to notify/obtain approval from the Alderman in whose ward votir proposed use of the public way islocated._
ALDERMAN'S SIGNATURE
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DATE