To: City of San Antonio Date

PETITION

* * * * * * *

TO: CITY OF SAN ANTONIO DATE:

FORMAL REQUEST FOR:

PURPOSE:

PETITIONER:

REPRESENTATIVE:

ADDRESS:

PHONE NUMBER: FAX NUMBER:

EMAIL ADDRESS:

PLEASE ATTACH A PLAT OF REQUESTED LOCATION AND CHECK OR MONEY ORDER FOR THE PROCESSING FEE (NON-REFUNDABLE) MADE PAYABLE TO THE CITY OF SAN ANTONIO. FEE SCHEDULE IS AS FOLLOWS:

$100.00 PERMIT (MINOR ENCROACHMENTS)

$815.00 LICENSE (MAJOR ENCROACHMENTS)

$815.00 RIGHT OF WAY CLOSURE

May be used for other miscellaneous requests

Return to: Marcia Shelf Orlandi, CIMS Dept., P. O. Box 839966, San Antonio, TX 78283-3966

Physical address: Municipal Plaza Bldg., 114 W. Commerce St., Room 207

THIS PAGE NEEDED FOR RIGHT OF WAY CLOSURES ONLY.

ABUTTING PROPERTY OWNERS (REQUIRED FOR CLOSURE OF PUBLIC RIGHT OF WAY ONLY):

ADDRESS:

NCB BLK LOT

OWNER(S):

SIGNATURE(S):

By signing this petition, the above signed abutting property owner agrees to the closure, vacation, and abandonment of certain Public Right of Way as requested by the petitioner. However, this agreement is not a quitclaim of any entitlement that the abutting property owner may have in the Public Right of Way.

ADDRESS:

NCB BLK LOT

OWNER(S):

SIGNATURE(S):

ADDRESS:

NCB BLK LOT

OWNER(S):

SIGNATURE(S):

ADDRESS:

NCB BLK LOT

OWNER(S):

SIGNATURE(S):

(ADDITIONAL PAGES OF THIS PETITION MAY BE PHOTOCOPIED IF NECESSARY)