Project Description

Project No.: Enter project #

Control Sec.: Enter control sec.

Project Name: Enter project name

Route: Enter route #

Parish: Enter Parish

Seal

Description of Work: Enter project location and description. Use shift+enter to start a new paragraph.

Provide supporting documentation/exhibits for the request. Exhibits should include title sheet and other plan sheets affected by the design waiver (i.e., typical sections, geometric details, plan/profile sheets). Additional documentation should include correspondence from other sections, agencies, etc., as well as site photos.

General Information

Reason for waiver

EDSM

MANUAL

OTHER (Describe)

Provide a synopsis of the scope of the project, the situation you are encountering and the problem you are attempting to mitigate.

Provide description.

Describe the proposed design waiver. Provide the proposed and standard values of the design waiver criteria.

Provide description.

Required Signatures

Recommended by: DESIGNER Please Print	Date:
Signature:

For LPA Projects:

Recommended by: Responsible Charge Please Print Please Print	Date:
Signature:
Approved by: Chief Executive Authority Please Print	Date:
Signature:

For All Projects:

Recommended by: Position Please Print	Date:
Signature:
Recommended by: DOTD Project Manager Please Print	Date:
Signature:
Approved by: Applicable DOTD Section Head Please Print	Date:
Signature: