MEMORANDUM FOR TRAFFIC REGULATION
PROHIBITION AGAINST PARKING (Except for the Disabled)
Applicant Name: RONALD MARCINIAK
Primary Street Address: 6402 S LONG, CHICAGO, IL 60638
Location Signs to be Posted: 6402 S LONG
Permit Number: 77264
Hours: At all times
Days: No Exceptions
ALDERMAN FRANK OLIVO, Ward 13
4
FRANK OLIVO
Alderman, 13th Ward 6500 S. Pulaski Road - 60629 Telephone: (773) 581-8000
CITY COUNCIL
CITY OF CHICAGO
COUNCIL CHAMBER
SECOND FLOOR, CITY HALL 121 NORTH LASALLE STREET
TELEPHONE: (312) 744-3076
COMMITTEE MEMBERSHIPS
AVIATION - COMMITTEES RULES and ETHICS FINANCE
LICENSE and CONSUMER PROTECTION BUDGET TRAFFIC CONTROL and SAFETY ZONING
January 4, 2011
Honorable Patrick O'Connor Chairman
Committee on Traffic Control and Safety 121 N. LaSalle Street, Room 300 Chicago, IL 60602
Dear Chairman O'Connor:
I wish to override the following application for handicapped parking signs:
6402 S. Long - #77264
Your assistance with this matter will be greatly appreciated. If you have any questions, please call Shari Knight at (773) 581-8000.
With kindest personal regards, I remain
Sincerely,
Frank J. Olivo Alderman, 13th Ward
T8STS5T
Wi oo;' ? :-mi
77264
APPUCATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETJNGJITJE^ORM
An application will not be considered complete unless: -^j- ^->-v-vJ^ <r\
All lines of the application have been completed in full; ""*A check or money order for S70.00 made payable to the City of Chicago is submitted as payment of the application fee.
*7Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plate y disability must be permanent as evidenced by a copy of your va[id disabled placard and/or,current vehicle/registration submitted at the time of application; Jl-^\~~^ u-^^^<l^lCiL-u^-xr-''i 0 f~7: 1 < 7)
" /submitted at tne time of application; J^-^J>^) j^^^S^AjslX*-**-^-.-^ G /> //Proof of residency, in the form of a copy of your drivers hcense>state identification, or utility bills are submitted at the \J time of application. , Q _
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100. Chicago. IL 60680-3100. ATTN: Disabled Permitting Section. A $25.00 maintenance-fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275).
1. Date of Birth
MO . _ 0»v
n\4>\ i\°t \s\?
2 State Identification Number
I 3. Drivers License Number
\P)\(o\ ol ?Ti d o 5
4. Applicant Last Name
P7I/) i\M\/\A\k
Ml
First Name
5. Home Address (primary residence)
[>IH I STREET NAME
, STREET NUMBER DIH | STREET NAME - n I
6\<j-\0\K\ S\L\o\hA6\ k ]/■■■
6. Address where signs will be posted
STREET NUMBER LXH I STHEET NAME A
b\/\Q\^\ kg 1 L\o\MC\ \A 11/1 \
7. Phone Numbers
Home
Business
r)n |3 T</| 3 j9T?t6
8. Current Permanent Disabled Placard Number
9. Current License Plate Number
Ir 9 /
it id
Registered to
Registered to
Cily Sticker No.
Relationship 10 Applicant
\ ... " ....._
Relationship to Applicant
JC(. > "________
10. Description of Medical Condition and Disability
Alternative Forking: Please note your application may be denied if you have alternative accessible off-street parking options
J YES T?NO
11. Is there off-street parking available at your primary residence (i.e garage, car port, driveway, etc.)?
12 If you answered Yes to question 11, please describe:
J Garage: J Driveway; J Car Port; J Other:
13. Is your off-street narking accessible? n /
□ Yes: AW Please explain: <TL£ £77? ,C fe^ / r /yV fl ^ /,- r, f
14. Affirmation: I hereby affirm that the above information is true and correct. If Ihe City of Chicago Department ol Revenue determines that the applicant has falsefy represented one or more of the above conditions, the applicant shall be subject to a fine of not less than $100 but no more than $500. and the application shall be denied. I also understand that it is my responsibility to notify the Department of Revenue of any changes in the information provided.
Signature .
Date
FOR OFFICE USE ONLY
-I FEE
PLACARD/PLATE
RESIDENCY
COMPLETE