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City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.ci.oshkosh.wi.us
REQUEST FOR SIDEWALK / DRIVEWAY APPROACH REPAIR
RETURN ORIGINAL, SIGNED FORM TO THE DEPARTMENT OF PUBLIC WORKS AT THE ADDRESS
LISTED ABOVE.
IN ORDER TO BE INCLUDED IN THIS YEAR’S PROGRAM, THIS FORM MUST BE RETURNED BY
SEPTEMBER 14TH.
_____________________________
Today’s Date
I, ________________________________________, as the legal property owner of
Print name
_____________________________________________________________________,
Property address
request the City of Oshkosh perform repairs to my existing sidewalk/driveway approach as listed below as part of
the City’s Sidewalk Rehabilitation Program. I understand I will be billed for all work performed and that there may
be additional items billed as required to complete the work.
Requested:
Removal and replacement of __________________ square feet of 4” thick sidewalk
# of square feet
Removal and replacement of __________________square feet of 6” thick sidewalk/driveway approach
# of square feet
Removal and replacement of __________________square feet of asphalt driveway approach
# of square feet
Authorized: Mailing Address (if different than listed above):
______________________________________ _________________________________________
Signature House number & street name
_________________________________________
City, State Zip Code
Contact Information:
Telephone No.: ________________________________
E-Mail Address: ________________________________