E-Gov Services Village of Wauconda

Block Party Request

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Purpose. This form is used to communicate with Village personnel to request barricades or obtain information related to having a block party.

* Information is required.

Contact Information

* First Name:
* Last Name:
Business Name:
* Email:
* Daytime Phone:	() –
Fax:	() –
* Address:
City:
State:
ZIP:

Requestor Location.

If the address is the same as above, please reenter the address here.

* Address	- Or Other Not Listed - Invalid Address The address you entered does not match any in the system. You can select a valid address from the list, or if you are certain the address you entered is correct click the "Use the address I entered" button, to continue. The address you entered
Unit:
	What is the location of your block party?

* What is the date and approximate time of the block party?

Other information or questions...

* Village barricades are available upon request. Barricades are to be picked up and returned to Public Works, located at 302 Slocum Lake Road. Are barricades needed for your event?

Yes

* How many barricades?

Attach a Picture or File (max size: 30MB):

Add Another FIle

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* Information is required.

Notes:

Upon submitting a request, you will receive a tracking number which may be used to follow up with your request at a later date. If an email address is provided, you may choose to receive a copy of your request via email which includes this tracking number.

Information we receive may be considered public information which is subject to disclosure under current state law.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.