Handicap Parking Sign Request Form

Applicant: Click or tap here to enter text.

Address: Click or tap here to enter text.

Phone: Click or tap here to enter text.

State of CT Handicap Parking Placard Number: Click or tap here to enter text.

Expiration Date: Click or tap to enter a date.

Is applicant the driver of the vehicle? YES ☐	NO☐

If no, please provide:	Driver Name: Click or tap here to enter text.

Driver Address: Click or tap here to enter text.

Do you have access to off-street parking (i.e. driveway)? YES ☐	NO ☐

If you answered YES please explain why you require an on-street space:

Click or tap here to enter text.

Please Note:

If a sign is placed near your residence, any vehicle with a valid handicap permit or placard may park in the space. It is not a reserved space solely for the applicant.

If the sign is no longer needed (move, death, etc.) the applicant must notify the Traffic Services Office as soon as possible.

Vehicle operators must follow winter parking regulations and bans regardless of placement of sign.

Tenants with driveways not permissible/accessible to them must obtain a letter from the landlord or property owner stating applicant’s prohibition to use such.

Applications are handled on an individual basis and are subject to evaluation by the Traffic Officer.

Approved ☐	Denied ☐ Date: Click or tap to enter a date.

Authorized By:	Choose an item.