APPLICATION FOR SPEED HUMPS OR SPEED CUSHIONS

To: City Traffic Engineer,

I am requesting speed humps or speed cushions on the following street:

Between the following two streets:

______________________________ and ____________________________________

I have read the Traffic Calming Policy Adopted by the Antioch City Council on
December 12, 2017 (available on line at:
http://www.ci.antioch.ca.us/CityGov/CommDev/Engineering/ or by requesting a copy
from the City Traffic Engineer at 925-779-7025), and understand the process for having
speed humps or speed cushions installed on this street.

I understand that submitting an application does not guarantee installation of speed

humps or speed cushions.

Name:______________________________________

Signature:___________________________________

Phone Number: ______________________________

Email: ______________________________________

Date:_______________________________________

With the exception of the signature, this application can be filled out on line. Please
complete the application and sign. The application can be faxed to 925-779-7062,
scanned and emailed to trafficcalming@ci.antioch.ca.us, mailed to Antioch Traffic
Engineer, P.O. Box 5007, Antioch, CA 94531-5007, or hand delivered to the Capital
Improvement Division in the basement of City Hall, 200 H Street.