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Street Maintenance Fee Request for Adjustment/Exemption

  1. Staff Use Only

  2. Location ID:

  3. Current Land Use:

  4. Revised Land Use:

  5. Units:

  6. Billing Code:

  7. Reason for Approval / Denial:

  8. City Engineer Signature:

  9. Leave This Blank:

  10. This field is not part of the form submission.