City Council Meeting January 13,2010
MEMORANDUM FOR T fcA ?F1C REGULATION
PROHIBITION AGAINS f P. IRKING (es i:epl for the disable)
NAME APPLICANT:
PRIMARY STREET ADDRESS: LOCAT ION SIGNS TO BI POSTED: PERMIT: HOURS:
DAYS:
CAROLYN CALHOUN
951 N. AVERS 951 N.A VERS 75946 ALL
ALL
Walter Burnett Jr, Alderman, 27th ward
1
APP1JCA10 M FOR DISAEJIi-D PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BE :OUE COMPLETING THE FORM
75946
An application will not be considered a
All lines ol the application heve bei
A check or money order lor S70 00 Please note' The application fee st
Disability must be permanent as e\ submitted at the lime of appiicatior
Proof ol residency, in the form of a ~x>p) of your drivers license, state identification, or utility bills are submitted at in* time of application.
mpii ite unless: n cc mpleted in full:
mace payable to the City ol Cnicago is submitted as payment ol the application fee: all b? waived for any person holding a valid, current disabled veterans c-iate iden:ed by a copy of /our valid disabled placard and/or current vend* regisddOon
Completed application forms may be r< facility, or via mail at P.O. Box 8C3100. fee will be billed to you annually Shou 744-PARK (72751
lurn. id lo: the offici! ol your alderman, any City of Chicago Department ol Mevenuu ^hieigo, IL60680-31'H3, ATTN: Disabled Permitting Section. A $25 00 maintenance d yc j have question;; or concerns, please call Oui permit processing division at 312'
i. Date ot Binh
4, Applicant La«;t Name
Oir\iuui-;m \h\ i
late identification Numl; ar
' . I ■:
:v Dnvors License Number
i...: .:...)!
Ml
5. Home Address (primary rcsidoncrl
STKEf NUWOL" :» I MHtETN»»IC
6. Address wrier© signs will bo posted
.r'.flMtmg. ■ i
7 Phone Numbers
7 O ^ "
...l... i j.....
|0:QO
First Name
._._i_iL_._^ _L
i : I
Home
LL
8 Current Permanent Disabled Placard Nu
....U..L
iber
9. Current Liconso Plaic Number
Hl-f<-/_,7_
______......I......I...
Bus nes_
-ILL.... "...
Registered in
.'. . . \____i.:j-4v-
Rogistci lid to ! Cily Slicker No
1
rtClflflO"SM;l* W. Apt1"!
10, Description ol Medical Condition nnd Dis ibilih.
iii. ^ ~-v. r*~ir........... _&ta_UUKi* \U.________LLh>_li_Vili::_i .
Alternative Parking: Please note youi applic: lion nay be oenisd il yi: .i haw alternative accessible oN-streoi aarkniq odik.i^
11 Is there off-street parking available at yoi (i.c garage, car port, driveway, erc.i'
12 it you answe'ed Ves to question 11. pi.a -I Garage: J Dnveway: .J Car F
pm iary residence -J irES Z) NO
e de scribe.
>rl J Other
13 Is your otl-strpel parking acco-si-lo1 □ Ves: .21 No Plaaso axpl.vn
14 Aflirmation: I hereby affirm thai tf_ abov thai the oppiicam has laisoly represented or Si00 bul no more than $500. and the applic Revenue o< any changes in ina infonnaiion |
: mlt rmation is irue nn<i <:orroi:t il the C'ly ot Chicago Department ot Routi ne ocu-iniii-,,;'-, ! or i nore ot ihe above sndiiums. the applicant snaii be subieci io a 'me o' nor less '.nan Hon ihali be denied. I &>'.-a understand thai it'S my responsibility to notify the- Dop.vinicni rovi( ed
Signature ^ ,iTV~U^C^-^''
Date ... C
FOR OFFICE USE ONLY
_ ____JTL
fl I PL ACARO/PLATE
RESIDENCY J COMPLETE "?q