FDOT LETTERHEAD - DOC by 5T5V071a

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									                           Florida Department of Transportation
  RICK SCOTT                                                     605 Suwannee Street              ANANTH PRASAD, P.E.
  GOVERNOR                                                                                           SECRETARY
                                                             Tallahassee, FL 32399-0450


                                                    MEMORANDUM
  DATE:
  TO:                Aran Lessard, P.E., Turnpike Structures Maintenance Engineer
  FROM:

  SUBJECT:           BRIDGE NUMBER ASSIGNMENT REQUEST

  1.       Bridge Number Assignment:                          (To be assigned by Turnpike Structures Section)
  2.       FM Number: __ __ __ __ __ __ - __ - __ __ - __ __
  3.       Design Firm:
  4.       County:                          Section:                           SLD Milepost:
  5.       Route Type:       U.S. Route              State Road               County Road
           Route Number:                             Direction:
  6.       Check appropriate bridge character description:
            Bridge carrying two-way traffic          Left bridge of twin bridges
            Right bridge of twin bridges             Ramp bridge
  7.       Length:                          Width:                             Spans:
  8.       Bridge Name:
  9.       Location:
  10.      Bridge over:      Railroad      Water        Roadway  Other:
  11.      Check appropriate bridge type(s):
            Low Level (less than 20')       Medium Level (20' - 45')          High Level (over 45')
            Movable Span                    Railroad                          Other
  12.      If a replacement, number of the existing bridge:
  13.      Identify bridge owner (responsible maintaining agency):
            FDOT District No. ____          Other State Agency                Federal Government
            County                          City                              Other:
            Privately owned bridge over Turnpike System

  NOTE: All information submitted should be for the proposed bridge and not for the existing. The plan and elevation
         sheet must be included with this request form.

  Signature:                                                                         Date:
                               (Person Initiating Request)

  Print Name:                                                                        Phone No.:

  6a9d818a-e5ab-4ec5-9be5-56a77c77dd24.doc
       Revised 4/10/07

Phone: (954) 975-4855                        FDOT Turnpike Operations Center                               www.dot.state.fl.us
Fax: (954) 934-1354            MP 65 on Florida’s Turnpike, Pompano Beach, Florida 33069                         Please Recycle
                           Florida Department of Transportation
  RICK SCOTT                                          605 Suwannee Street                  ANANTH PRASAD, P.E.
  GOVERNOR                                                                                    SECRETARY
                                                  Tallahassee, FL 32399-0450


  Firm:




  6a9d818a-e5ab-4ec5-9be5-56a77c77dd24.doc
       Revised 4/10/07

Phone: (954) 975-4855                        FDOT Turnpike Operations Center                        www.dot.state.fl.us
Fax: (954) 934-1354            MP 65 on Florida’s Turnpike, Pompano Beach, Florida 33069                  Please Recycle

								
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