Request for Temporary Use / Closing of Roads / Parking / Sidewalks or Other Paved Area
Location (Describe and note on attached map):
Dates and Time of Usage Requested:
Extent of Usage (road width, no. of lanes, etc.):
Controls to be Provided (barricades, flagmen, etc.)
Requested By: __________________________ ______________
Project Officer Date
__________________________________________________________________
Approved By: _____________________________ _______________
Grounds Maintenance Date
and Landscaping Section, ORF
___________________________ _______________
Fire and Emergency Response Date
Section (NIH Fire Dept.), DPS
___________________________ _______________
Police Branch, DPS Date
Comments or Conditions Imposed by Approving Officials:
________________________________________________________
________________________________________________________
________________________________________________________