CITY OF NEWTON
Street Closure Request
Reset Form
(Non-Construction Events Only)
Print Form
Note: City Clerks office must receive completed form at least 1 Month for "thoroughfares"
and 1 week for "block parties" prior to the event.
Date of request:
Organizer (contact person):
Address (home):
Zip Code:
Representing (organization name):
Address:
Zip Code:
A contact phone number is required. Fax and email are optional.
Phone:
Cell:
Fax:
Email:
What is your event?
Event Date(s):
Start time:
End time:
Purpose:
Will your event be in a City Park?
Yes
No
If yes, what park?_________________________________
Projected number of participants:
Proposed Street Closure: ___________________________ From: ____________________________ To:_____________________________
Proposed Street Closure: ___________________________ From: ____________________________ To:_____________________________
Proposed Street Closure: ___________________________ From: ____________________________ To:_____________________________
Proposed Street Closure: ___________________________ From: ____________________________ To:_____________________________
If other City services or amenities are requested for the event, please detail below (i.e. picnic tables, trash receptacles, snow fence, etc.):
Acknowledgement by organizer / responsible party:
The undersigned does hereby acknowledge that the City of Newton requires that any Street / Block Closure granted
by the City of Newton will conform to all applicable local ordinances and state laws.
Duly signed by:_______________________________________________________
Print or type name here:
Fee Paid
Block Party Barricades to be delivered for a $20.00 fee to:
Name:
Address:
Phone:
Street Closure Barricades for full community events to be set-up as per city detour requirements.
Please indicate if the following are in the area (check all that apply):
Nursing home
Day care
Multi-family apartments
Signatures are required for the Street / Block Closure. All properties, within the requested area, must be notified of the request for local
street / block closure as detailed on this application form. Each property must indicate support (Y) or opposition (N) in the appropriate
column.
This request must be circulated to all households/businesses within the requested street closure area prior to City consideration.
Consideration of the request will only occur if at least 60% of the signatures of residences and or businesses in the affected local street /
block closure area approve. Signatures from each household/business within the requested area must appear on the attached form.
Send completed request to:
City of Newton
Administration Office
201 E. 6th St. Newton KS. 67114
316-284-6001
Fax: 316-284-6090
dduerksen@newtonkansas.com
(please note: City Clerks office must receive completed form at least 1 Month for "thoroughfares"
and 1 week for "block parties" prior to the event.)
Approved
Date organizer notified of approval or decline:____________________________
Declined
Signed by:
___________________________________________________________________
____________________________________
City Official
Date
Sign, date, and forward to the following departments (office use only)
Newton Police Department:
_____________________________________________________________
Public Works Department Street /Sanitation:
_____________________________________________________________
Public Works Department Engineering:
_____________________________________________________________
Newton Fire/EMS Department:
_____________________________________________________________
Parks Department:
_____________________________________________________________
911 Communication:
_____________________________________________________________
KDOT Notified:
Date Sent: ____________________
Date Approved: ____________________
Required of Applicant
Business and Resident Signature Approval for Street / Block Closure
We, the undersigned, do hereby acknowledge the street closures for the __________________________ event on ______________ From:______________To:______________ as
detailed on the attached.
(Name of)
(Date)
(am/pm)
(am/pm)
*** Please check the appropriate column specifying support for Street / Block Closure (mark the appropriate column as "Y" (support), or "N" (oppose).
NAME
ADDRESS
DATE
STREET / BLOCK
CLOSURE (Y or N)
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