MSHA_Lane_Closure_Application.pdf
PDF 15 KB Posted
- Attached to
- Baltimore-Washington Parkway
- Solicitation number
- DTFH71-16-B-00034
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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 .