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2. This form is not for special event closures. For special event closures please contact the Clerk's Office at (765) 807-1021.
4. Road/Street/Sidewalk Closure Request
   Please fill out the form completely. Incomplete forms and/or incomplete information will cause a delay in the processing of your request.
6. First Name*
7. Last Name*
9. Email Address*
10. Phone Number*
12. Reason for Closure*
14. Closure Location(s)*
    Please give a detailed description of the area(s) to be closed. Please be specific.
16. Beginning Closure Date *
    Beginning Closure Date
    36 HOUR NOTICE REQUIRED. If you need to cancel this request or change the dates you must contact our office at (765) 807-1055. Failure to do so could result in fines.
17. Ending Closure Date*
    Ending Closure Date
19. Detailed Summary of Closure*

    This will be used to send a media notice to the public and emergency responders. Please provide us with a detailed description of: (1) how much of the affected area is going to be in/under construction or closed; and, (2) what equipment, signage, and flagmen, (if any) will be used in the right of way.

21. Map Attachment*
    Please attach a map showing the area(s) to be closed.
22. Other Attachment
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field