Special Case Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Purpose: The purpose of this form to collect basic information in order to begin processing a Special Case request.

Definition of a Special Case: A request to install utilities in ADOT rights-of-way that is either already identified as a Special Case or does not meet the guidelines listed in the ADOT URR Accommodation Guidelines located at: https://azdot.gov/sites/default/files/2019/05/urr-accommodationg-guideline_august-2015.pdf

To initiate the Special Case Request process, please complete the form below and an ADOT District Permits Office representative will contact you.

Email *

Name of Requestor *

Name of Company *

Please provide the best phone number for us to reach you at: *

In which ADOT District does the encroachment permit begin? *

Permit District Maps can be found at the following link: District Contacts

Please provide the location of where the Special Case is being requested. Use Route/Milepost (MP) format. *

Example: US-60 / MP 123.4 - 124.4. MP's can be found on AZ511.gov.

Please describe the Special Case you are requesting: *

For example, the ADOT Utility and Railroad (URR) Accommodation Guidelines requires 48" depth of cover and we are requesting 30" because of ____________. Another example: we are requesting to install fiber optic cable longitudinally along the Interstate.

Please verify you have read and understand each of the requirements below: * *

A. The accommodation will not adversely affect the safety, design, construction, operation, maintenance or stability of the highway;

B. The accommodation will not interfere with, or impair the planned future expansion of the highway;

C. Any alternate location would be contrary to the public interest. This determination may require an evaluation of the direct and indirect environmental, aesthetic and economic effects of the locations under consideration;

D. Except in prior rights cases, ADOT will not incur any unreimbursed additional expense or maintenance costs associated with the utility installation;

E. The preferred location of any utility is outside the roadway pavement, but if it is necessary to locate a utility under the pavement, any lane disturbed will be replaced full width.

F. State shall not be liable for any claims, demands, costs or expenses, including all legal expenses, for loss, damages or injury to any person or property, including third parties' persons or property, due to the Utility’s use of the ADOT Right-of-Way, unless caused by the willful or negligent acts or omissions of ADOT, its officers, or agents.

Required

On a scale of 1-5, how easy or difficult was it to fill out this form? *

Very Easy

Very Difficult

What would make this form better? *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of State of Arizona. Report Abuse

Forms