Safe Sidewalks Program Application

Safe Sidewalks Program

Reimbursement Application, Work Authorization and Permit Form
- APPLICATION MUST BE SUBMITTED BY MARCH 31 OF THE CURRENT FISCAL YEAR PRIOR TO PERMIT ISSUANCE AND COMMENCEMENT OF WORK
- ALL PROGRAM & INSURANCE REQUIREMENTS MUST BE SATISFIED
- REPAIR WORK MUST BE COMPLETED BY JUNE 30 OF THE CURRENT FISCAL YEAR
Applicant Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Repair Information
Description of specific sidewalk location
Contractor's cost estimate
Anticipated project start date

MonthDayYear
Repair work must be completed by June 30, 2022
File Upload

Attach photos of repair information and specific sidewalk location
Cancelof
Contractor Information
PRINT NAME
Applicant name
SIGNATURE

Clear
DATE

MonthDayYear
Date
Note: Applications will be processed on a first come, first serve basis. Submittal of an application does not guarantee City reimbursement for sidewalk repairs.

Submit completed applications to: Safe Sidewalks Program, Public Works Streets Division, City of Ventura, 336 Sanjon Road, Ventura, CA 93001. Click here for PDF copy of this application and submit by email to SafeSidewalks@cityofventura.ca.gov

For additional information please contact Public Works Streets Division at (805) 652-4515 or visit www.cityofventura.ca.gov/SafeSidewalks.
In compliance with Americans with Disabilities Act, the document is available in alternate formats by calling the City of Ventura Streets at (805) 652-4515 or by contacting the California Relay Service.
Public Works Pre inspection by
DATE

MonthDayYear
Date
Work Authorization Permit Number
Estimated Reimbursement Amount

5075% with low-income documentation attachedCDBG 100
I HEREBY PERFORMED THE INSPECTION, AND ACCEPTED THE SIDEWALK CONSTRUCTION:
PRINT NAME
DATE

MonthDayYear
Date
APPLICAITON APPROVED BY
Environmental Sustainability Manager
DATE

MonthDayYear
Date
Reimbursement Request for Payment submitted to Treasury:

MonthDayYear
Date
Should be Empty: