Commonwealth of Virginia LUP-SEI
Department of Transportation LAND USE PERMIT
7/2010 Special Events
Information Sheet
Please Type or Print Clearly
TYPE OF EVENT (Parade, March, Walk Bike-A-Thon, Block Party, etc.):
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DATE OF EVENT: ______Inclement Weather Date: ______
Beginning Time: ______A.M./P.M. Ending Time: ______A.M./P.M.
ROUTE OF EVENT (Attach detailed map including Event Starting & Ending Point,& State Route No.):
______
______
______
______
NAME OF APPLICANT/ORGANIZATION: ______
Mailing Address of Applicant/Organization: ______
______
______
CONTACT PERSON: ______
Mailing Address of Contact Person: ______
______
______
Telephone No.: ( _____ ) _____ -______
E-Mail Address: ______
SPECIAL EQUIPMENT REQUEST:
Cones No. Requested: ______
Advance Warning / Event Ahead Signage No. Requested: ______
Variable Message Board Message: ______
______
I, the undersigned hereby acknowledge that I am fully cognizant of the attached requirements associated with the issuance of a VDOT Land Use Permit to hold parades, marches or similar special events on state maintained highways.
______Date: ______
(Signature of Applicant)
______
______
SPECIAL EQUIPMENT REQUESTED:
Cones No. Requested: ______
Advance Warning / Event Ahead Signage No. Requested: ______
Variable Message Board Message: ______
I, the undersigned hereby acknowledge that I am fully cognizant of the attached requirements associated with the issuance of a VDOT Land Use Permit to hold parades, marches or similar special events on state maintained highways.
______Date: ______
(Signature of Applicant)