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2. Sumter County Board of County Commissioners
   7375 Powell Rd
   Wildwood, FL 34785
   Phone: (352) 689-4400 Fax (352) 689-4401
   
4. TEMPORARY ROAD CLOSING REQUEST
   
   Please submit request a minimum of three weeks prior to the event.
6. Requested by:*
8. Date:*
10. Address:*
12. City, St, Zip:*
14. Phone & Fax #:*
16. Email Address*
18. Organization:*
20. Date(s) Requested:*
22. Road(s) or Portion to be Closed*
24. If Parade - Detailed Route
26. Attach map if applicable
28. Requested Time for Road Closure*
30. Requested Assistance or Equipment*
32. Date(s) Needed:*
34. We understand that any request approved will be upon the following terms and condisions:
36. 1. We shall be responsible for all safety and maintenance requirements in connection with the event.
38. 2. We shall indemnify and hold the County harmless as to any liability which may result from any aspect of the event.
40. 3. We shall be responsible for clean-up work which may be required as a result of the event.
42. 4. It is understood that any request approved by the County shall in no way be construed by us to allow our event to take place on a State Road, and that any request approved is limited to the portion of the County Road described.
44. 5. We agree that we shall make every effort for all participants in the event to comply with all state and local laws, and that the County Road mentioned above will be closed to the public only the day and time mentioned above, but not in excess of hours shown here:.*
46. The Applicant agrees that by typing their name in the box below constitutes an electronic signature and agrees to these terms and conditions.
    
48. OFFICE USE ONLY:
50. 
    This request was approved in open session of the County Commissioners meeting this _____ day of ___________________, 20____.
    
52. Attest by:
    _______________________________________
53. Chairman:
    __________________________________________
    
    
    
    
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit Submit and Print

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