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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.