MSHA_Lane_Closure_Application.pdf

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Attached to
Baltimore-Washington Parkway Federal contract opportunity
Solicitation number
DTFH71-16-B-00034
Issued by
Department of Transportation Federal Highway Administration

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Appendix MSHA Lane Closure Application

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Text version

MARYLAND STATE HIGHWAY

LANE CLOSURE PERMIT/SCHEDULE

Date: Contract / Permit #:

Starting County: Ending County:

Montgomery County

Prince George’s County

Montgomery County

Prince George’s County

Route No.:

Intersection: or Exit:

Limits: From: To:

Mile Posts: From: To:

Lane:

Left Shoulder Lane 1 Lane 2 Lane 3 Lane 4

Lane 5

Right Shoulder

Other

All

Direction:

North

South

East

West

Inner Loop

Outer Loop

Start Time: ______________________________ Stop Time: _________________________________

ADC Map Page No. : ________________________ADC Grid No. : _____________________________

SHA Traffic Control Standard No: _____________________Type of work: _______________________

Start Date: ______________________________ Stop Date: ______________________________

Days:

Sun Mon Tue Wed Thur Fri Sat

SHA Contact Name: ______________________________Telephone No.: ______________________________

Field Contact Name: ______________________________ Telephone No.: _____________________________

Traffic Control Manager:___________________________ Telephone No.: _____________________________

Remarks:_______________________________________________________________________________________

Return Fax No. _________________________________________________________________________________

**NOTE ** Request for lane closure must be made at least two days (48 hours) prior to actual closure. Weekend and Monday request must be in by Thursday.

Fax No. (301) 513-7490

Revised 11/19/15

Intersection: or Exit:
SHA Traffic Control Standard No: _____________________Type of work: _______________________

File details come from the government source that posted it. Updated .