Special Request Application - Borough of Middletown, PA

Note: This application is to be used for persons requesting permission to deviate from the Borough's regulations, for which there are no other forms. Examples include, but are not limited to, Temporary No Parking Requests: Permission for placement of dumpster or other similar item on Snow Emergency Route between December 1st and March 31st; Permission to encroach onto public sidewalks; etc.

Applicant
Applicant Name*
Address*
Street Address City State ZIP Code
Contact Person
Contact Name*
Email*
Contact Phone*
Your Request
Description of Your Request*
Location of / for request
Start Date*
Start Time*

: HH

MM
End Date*
End Time*

: HH

MM
NOTE: This request form will be forwarded to the appropriate party(s) for review and disposition. You will be contacted regarding the final disposition. Some examples include:

Temporary No Parking Requests are dispositioned by the Mayor: Code Sec. 252-3A (this includes requests for placing a dumpster on street, except for Snow Emergency routes, from Dec. 1st through March 31st.

Placement of dumpster or other similar item on Snow Emergency route from December 1st through March 31st are dispositioned by Borough Council: Code Sec. 252-34.1

Encroachment requests onto public sidewalks and other public places / properties are dispositioned by the Borough Manager. If approved, there is a $25.00 fee. Code Sec. 235-36 (this includes requests for placing dumpsters on the sidewalk or other Borough properties)

Requests for Sales during events held in public places (Code Sec. 195-4.D. (1) a: and road closures for special events / maintenance are dispositioned by Borough Council. (Code Sec. 252-5)

Submit request forms to: Borough o[Middletown 60 W. Emaus St. Middletown, PA 17057, Attn: Borough Secretary.

Borough Staff - dispositioned forms are sent to the Borough Secretary for record purposes.
Name
This field is for validation purposes and should be left unchanged.

Applicant

Contact Person

Your Request