Mar 08 20%1 10:54RM HP LASERJET FRX
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
67801
An applii'aiiu.1 '.viii nr;f oe corw.dert.'ri compile unlpss: AG lines ot tho application have bsen completed in full;
A check or money order tor $70.00 made payable to tne Cily cl Chicago is auatnittad s$ payment or tn« application tee:
Ptease riote: The application tee snail be waived for any person holding n vahd, current d;sabied veis r.sr.&-pcaio. CNsabtity mwsi be permanent as evidenced by a copy of vow valid disabled ptestrd and.'or curr-wii veiade respiration
suiNTinted at the time of aviation: » Proof of residency, in the form of a oopy o# your drivers heanstr, state idenf.fsca'.ie'i ui t,s<!ay Mrs a-e- submitted at thfe
time of sppfical'on.
Crwnplehad application forms may tw raturned to: the office v" yew aiderman. any C*i«y or Chicago Ofepartrowit of P«v<sr»uui facility, or via msl at P.O. Bo* 803JOO, Chicago. IL 60680-3UX), ATTN: DisnWed Fenr.>t'.irtg Section. A $20.00 mawitertange fee wifi be billed to you annually. Should yon have questions or rancerns. ptease call our pemrwt p"ct»3si«<t dMsicfs sl 3t2-744-^aRK (7275).
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i 8 Mfdres;; vfft«re signs will i«9 posted ■ Phone Nun-iO^s Home
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3. Currant Pemwnenl Disabled1 Ptacafi Nixttbm
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HegsUireel to
City Slicker :
i 10 Description ot Medtial Condtton ano Disability
Alternative Parking^toaso role your Bppitc&w.i
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I 11. is trwn? ofi-siroet parking avaBabte ar your primary resiwtencc ' ('. ii- gatagc. car port, aiiwcway, etc)? _
be deniad if yoti hav» ato?iwiliv« «cco»c»trt& oft-strtwi paiiMrig opwoosi. □ YES &iiO
f 12 K you amswered Vi»« to queshon ti, ple>ase deschoe:
i_□ Garage; □ QrivHwu,y; □ Car fori; U Otttfer:
f~13~feTyouf o«-9lroet parturjg accotwible? I Q Yes; □ No Pif.'aso cxptaht:
1-4. Alfirmatlcio I herety »B»m» ihdt *» above infoimafcOTi Is true «nc! co-.iod. B the C'.«y of Cfc^ago DBpartmon! of »t!ve.'iuo Ootefmine* Ihat ihe appi«arir nas laiaaty rgpfeawited one or mort> ol irje above conoifiivis. «w ?p{iiic;4n! sf-aii iw subj^c: i? s i>rw u\ noi ifiss th*r. $ 106 but no more lha/i $500, and the application flhah be denied. I also understanct that if is my r«?#or«ib«iy to ^oufy Dtioartmant ot Revenue of ariy changes in the information provided.
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FOR OFFICE USi
FEE
LACARD/PLATE
ESIDENCY
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J COMPLETE
Mar 08 2CTU 10:54flM HP LASERJET FAX
City of Chic* go Richard M. Daley, Major
Departaettt of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107 A 121 North LaSalle Street Chicago, IIKnois 60602-1288 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
January 31, 2011
ALDERMAN EUGENE SCHULTER WARD 47
4237 N LINCOLN AVE. CHICAGO, IL 60618
Dear ALDERMAN SCHULTER:
The Department of Revenue recommends installation of disabled parking signs as described below. The application has been reviewed and a survey of the location has been conducted. Since the applicant has met the requirements outlined in the Municipal Code, the signs will be installed.
Provided is the name and address of the applicant, the exact location proposed for the signs, and the permit number assigned. Please introduce an ordinance to post residential disabled parking signs at the location recommended, if one has not yet been introduced.
Applicant's Name: ROBERT A DESAGUN Applicant's Address: 1755 W WAVELAND AVE Address/Location of Signs: 1755 W WAVELAND AVE
Permit Number: 67801
Work Order Number: H11-096
If the proposed ordinance is not passed within four months after its introduction, the permit shall be revoked and the restricted parking signs removed. Should you have any questions or require additional information, please contact our office at 312.742.7434.
Very truly yours,
Anthony Gambino Manager of Parking
Enclosure: Disabled Signs Application