Attachment 8

Form MT-159 9/92

NEW JERSEY DEPARTMENT OF TRANSPORTATION

ACCESS PERMIT APPLICATION

REQUEST FOR WAIVER

Please complete one copy of this form for each waiver request.

ROUTE NO.:
DIRECTION:
MILEPOST:
BLOCK:
LOT:
MUNICIPALITY:
COUNTY:

REASONS FOR THIS WAIVER REQUEST

(check where appropriate)

A WAIVER FOR RELIEF FROM ACCESS CODE PROVISION, N.J.A.C. 16:47- , IS REQUESTED FOR THE FOLLOWING REASONS:

1.	Existing substandard conditions
2.	Existing social, economic or environmental constraints
3.	Unique character of a lot
4.	Unreasonableness of strict application of the Access Code under particular circumstances
5.	A boundary such as urban/rural, speed limit, or access classification falling within frontage of the lot
6.	A lot within an urban enterprise zone
7.	Conflict between the requirements of the Access Code and the requirements of
(name of agency)
(conflicting statute or regulation citation)
8.	Lower access classification or capacity of the State highway than that applicable to an intersecting
county or municipal street
9.	Municipal, county or other approving agency imposition of conditions beyond the control of the
Applicant
10.	Low or moderate income housing, proposed pursuant to the Fair Housing Act
11.	Evidence that the major or minor type of permit which the Department would determine pursuant to
N.J.A.C. 16:47-4.4 is inappropriate
12.	Other reason:
(Please specify)

JUSTIFICATION:

Access Design Guidelines

Access

Access Design Guidelines

Paul Ignarri

2012-05-01

Lawrence, Glenn

Snehal Patel

NJDOT