CDOT Form 112 "State Highway Access Code - Design Waiver" - Colorado

What Is CDOT Form 112?

This is a legal form that was released by the Colorado Department of Transportation - a government authority operating within Colorado. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2017;
  • The latest edition provided by the Colorado Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CDOT Form 112 by clicking the link below or browse more documents and templates provided by the Colorado Department of Transportation.

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Download CDOT Form 112 "State Highway Access Code - Design Waiver" - Colorado

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COLORADO DEPARTMENT OF TRANSPORTATION
STATE HIGHWAY ACCESS CODE - DESIGN WAIVER
Local Jurisdiction
State Highway No/Mp/Side
Permit No. (if approved)
Region/Section/Patrol
WHEN USED, THIS FORM SHALL BE ACCOMPANIED BY AN ACCESS PERMIT APPLICATION.
1. State specific reasons for this waiver request. Documents verifying statements should be provided with the request. State the specific sections of the State
Highway Access Code from which this request seeks relief. (Additional sheets may be attached). If waiver is temporary, state conditions which will change
allowing the access to conform to the access code. If date is known when conformance can be achieved, provide that date.
NOTICE: Providing false information to a government agency is punishable as perjury in the second degree, as well as being punishable under any other
applicable state or federal laws.
This form submitted by
Date
(x)
ITEMS BELOW THIS LINE ARE FOR OFFICE USE ONLY.
2. Recommendation of local government authority. When local government has issuing authority, this recommendation must be signed by an authorized
offical. (provide written statement)
Date
(x)
3. Recommendation of region traffic and safety engineer or design engineer: (provide written statement)
Date
(x)
4. Recommendation of the region access manager: (provide written statement)
Date
(x)
FINAL ACTION TAKEN BY THE REGION TRANSPORTATION DIRECTOR:
Having reviewed this waiver request and all materials attached, I hereby
approve,
deny, this request for waiver from the design standards of the State
Highway Access Code. (signature shall be that of a registered professional engineer)
Date
(x)
CDOT Form # 112 05/17
Copy distribution, required copies 1. Region permit files 2. Staff Access Section.
Previous editions are obsolete and may not be used
COLORADO DEPARTMENT OF TRANSPORTATION
STATE HIGHWAY ACCESS CODE - DESIGN WAIVER
Local Jurisdiction
State Highway No/Mp/Side
Permit No. (if approved)
Region/Section/Patrol
WHEN USED, THIS FORM SHALL BE ACCOMPANIED BY AN ACCESS PERMIT APPLICATION.
1. State specific reasons for this waiver request. Documents verifying statements should be provided with the request. State the specific sections of the State
Highway Access Code from which this request seeks relief. (Additional sheets may be attached). If waiver is temporary, state conditions which will change
allowing the access to conform to the access code. If date is known when conformance can be achieved, provide that date.
NOTICE: Providing false information to a government agency is punishable as perjury in the second degree, as well as being punishable under any other
applicable state or federal laws.
This form submitted by
Date
(x)
ITEMS BELOW THIS LINE ARE FOR OFFICE USE ONLY.
2. Recommendation of local government authority. When local government has issuing authority, this recommendation must be signed by an authorized
offical. (provide written statement)
Date
(x)
3. Recommendation of region traffic and safety engineer or design engineer: (provide written statement)
Date
(x)
4. Recommendation of the region access manager: (provide written statement)
Date
(x)
FINAL ACTION TAKEN BY THE REGION TRANSPORTATION DIRECTOR:
Having reviewed this waiver request and all materials attached, I hereby
approve,
deny, this request for waiver from the design standards of the State
Highway Access Code. (signature shall be that of a registered professional engineer)
Date
(x)
CDOT Form # 112 05/17
Copy distribution, required copies 1. Region permit files 2. Staff Access Section.
Previous editions are obsolete and may not be used