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Deaf, Blind or Autistic Child Sign Request Form

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The City of Owatonna Engineering Department
Deaf, Blind or Autistic Child Sign Request Form
Date
Date
Name*
Phone Number*
Email Address
Address*
City
State
Zip Code
Type of Sign Requested*
Please Select One
1. Deaf Child
1. Blind Child
1. Autistic Child
Comments
I agree to notify the City of Owatonna at such time as the sign is no longer necessary. I have been provided with a copy of the City of Owatonna Deaf, Blind or Autistic Child Sign Policy.
Type full name to agree to preceding statement.
Approved By
Date
Date
Date Installed
Date Installed
Follow Up Date (5 Years from Installation)
Follow Up Date (5 Years from Installation)
Date Sign Removed
Date Sign Removed
Notes

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Deaf, Blind or Autistic Child Sign Request Form