TrafficForm

City of Thornton

TRAFFIC CONTROL PERMIT

When this form is submitted, you will receive a PDF copy of the application that you may print or save for your records.

PERMIT DESCRIPTION:

CERTIFICATION: THE UNDERSIGNED HEREBY CERTIFIES THAT I/WE AGREE TO ASSUME ANY AND ALL RESPONSIBILITY AND TO ABIDE BY ALL RULES, REGULATIONS AND CONDITIONS AS SET FORTH IN THE CITY OF THORNTON RULES, REGULATIONS, CONDITIONS AND STIPULATIONS (REFER TO NEXT PAGE) OF THIS PERMIT, AND CODES FOR TRAFFIC CONTROL. THE UNDERSIGNED SHALL FOLLOW THE MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES, LATEST EDITION, AS IT RELATES TO THIS PERMIT AND SPECIAL CONDITIONS. IF ANY REQUIREMENTS OR CONDITIONS OF THIS PERMIT ARE NOT IN COMPLIANCE, THE PERMIT SHALL BE REVOKED BY ORDER OF THE TRAFFIC ENGINEER. I/WE AGREE TO VACATE THE RIGHT-OF-WAY AS DIRECTED BY THE TRAFFIC ENGINEER.

SPECIAL CONDITIONS

REQUESTING PERSON OR AGENT (SIGNATURE)

REQUESTING PERSON OR AGENT'S ADDRESS

REQUESTING PERSON OR AGENCY TITLE

REQUESTING PERSON OR AGENT'S TELEPHONE NO.

TYPE OF PERMIT REQUESTED:

STATEMENT OF PERMIT REQUESTED:

DATE(S) REQUESTED:

FROM:

MO/DAY/YR

TO:

MO/DAY/YR

OVER SIZE VEHICLE	RIGHT-OF-WAY CLOSURE	PARKING RESTRICTION CHANGE
SPECIAL RIGHT-OF-WAY USAGE	SPEED LIMIT REDUCTION (CONSTRUCTION ZONE ONLY)	OTHER