Street Closure Form
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1STREET, LANE, OR SIDEWALK
CLOSURE/USE AUTHORIZATION
CALL THE TRANSPORTATION ENGINEERING BUREAU AT (407) 246-3704 FOR AUTHORIZATION
TRAFFIC INSPECTOR: 74 OR 75
AUTHORIZATION NO:
LOCATION 1:
SIDEWALK 1:
LOCATION 2:
SIDEWALK 2:
LOCATION 3:
SIDEWALK 3:
DIRECTION & LANE(S) 1:
DIRECTION & LANE(S) 2:
DIRECTION & LANE(S) 3:
CLOSURE STATUS ( Please check all fields that apply)
FULL
SIDEWALK
CONSTRUCTION
CITY PROJECT
DAILY
LANE
EMERGENCY
EVENT
OTHER ACTIVITY
CONTINUOUS
PERMITS
ENGINEERING
BUILDING
RIGHT OF WAY
F.D.O.T.
OTHER/18A
DATE:
APPLICANT:
PHONE:
PAGER:
TIME:
ORGANIZATION:
T.C.P. COMPANY:
ACTIVITY OR EVENT:
T.C.P./INDEX:
SIDEWALK PLAN/INDEX:
DATE CLOSED:
TIME CLOSED:
DATE OPENED:
TIME OPENED:
T.E.B. APPROVAL:
TO:
DATE:
TIME:
COMMENTS:
EMERGENCY SERVICES NOTIFICATION
NEWS
YES
DATE ______ 1 TIME/PERSON
DATE ______ 2 TIME/PERSON
DATE ______ 3 TIME/PERSON
RELEASE
NO
246-2414
O.P.D
O.F.D.
246-2141
578-9760
AMBULANCE
BUS
841-2279
(3568)
F.D.O.T
858-5900
T.M.C.
246-2334
M.T.C.
644-2277
420-5411
SENTINEL
COMMON ABBREVIATIONS
N- NORTH
W - WEST
NW - NORTHWEST
NE- NORTHEAST
NB-NORTHBOUND
WB-WESTBOUND
LT-LEFT
CTR-CENTER
S-SOUTH
E-EAST
SW-SOUTHWEST
SE-SOUTHEAST
SB-SOUTHBOUND
EB-EASTBOUND
RT-RIGHT
rev11/99
White Copy: Trans. Eng. / Canary Copy: Traffic Inspector
Pink Copy: Construction Management (As Required)
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