HomeMy WebLinkAboutTRF_Convex_Mirror_for_County_Road_Intersection_FillableINSTALLATION OF A CONVEX MIRROR
FOR TWO COUNTY ROADS
DPW Form 41(1) 11/20/14 County of Hawai‘i
DEPARTMENT OF PUBLIC WORKS ENGINEERING DIVISION
INSTRUCTIONS FOR APPLICANT:
1)Fill out top portion of form and sign at the bottom.
2)Mail to ENGINEERING DIVISION AUPUNI CENTER, 101 PAUAHI STREET, SUITE 7, HILO, HI 96720
APPLICANT:
MAILING ADDRESS: PHONE:
NAMES OF COUNTY ROAD(S)/STREET(S) MIRROR TO BE LOCATED:
FOR OFFICE USE ONLY
This form shall be routed and processed in the following order:
1.ENGINEERING DIVISION:
The p osted speed limit for the t hrough street is miles per hour ( mph).
Based on the posted speed limit plus 5 mph, American Ass ociatio n of State Highwa y and Transportatio nOfficials (AASHTO) guidelin es recommend sight distances of:
feet to the right and feet to the left
There is sufficient intersection sight distance in accordance with AASHTO guidelines and the applicant has been so notifiedby the attached letter.
There is insufficient intersection sight distance in accordance with AASHTO guidelines. Corrective work by the applicable
property owner(s) will be pursued following the provisions of Chapter 22, Section 22-2.2 of the Hawai‘i County Code. Theapplicant has been so notified by the attached letter.
There is insufficient intersection sight distance in accordance with AASHTO guidelines. Corrective work by the applicable
property owner(s) is not practical or will not provide minimum intersection sight distance recommended by AASHTOguidelines. This form is forwarded to the Highway Division for further evaluation.
By:Date:
2.HIGHWAY MAINTENANCE DIVISION:
We are able to increase intersection sight distance, at a reasonable cost using in-house resources, to meet the minimum
intersection sight distance recommended by AASHTO guidelines. The applicant has been so notified by the attached letter(copy sent to Engineering).
We are unable to increase intersection sight distance, at a reasonable cost using in-house resources along the County road to
meet the minimum intersection sight distance recommended by AASHTO guidelines. This application is forwarded to the Traffic Division for the installation of a convex mirror.
By:Date
3.TRAFFIC DIVISION:
Convex mirror will be installed and the applicant has been so notified by the attached letter (copy sent to Engineering).
By:Date:
The undersigned understands that this form will be used for review purposes by the Department of Public Works. The installation of the
convex mirror is subject to the approval of this request. Applicant will be notified by mail.
By: APPLICANT’S SIGNATURE
Date:
County of Hawai‘i is an Equal Opportunity Provider and Employer