Detour Permit Application Form

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APPLICATION BY MUNICIPALITY FOR PERMISSION TO
DETOUR WASHINGTON COUNTY TRUNK HIGHWAY TRAFFIC
(Revised 5/18/16)
APPLICANT INFORMATION
THIS SECTION IS TO BE COMPLETED BY
THE HIGHWAY DEPARTMENT
Name: _____________________________________________________
PERMIT NUMBER:
Mailing Address: _____________________________________________
__________________
City: __________________________ State: _____ Zip: ____________
Phone: (
) ______________________________________________
*Select preferred method of contact upon
Fax: (
) _________________________________________________
approval or denial (check one)
Email: _____________________________________________________
⃝ Mail
⃝ Fax
⃝ Email
DETOUR INFORMATION
Municipality: ⃝ Town
⃝ Village
⃝ City
of _______________________________
County Trunk Highway to be closed: __________
Closure beginning point: ____________ Closure ending point: ____________
Date(s) of proposed detour: _______________
Times of proposed detour: ____________ to ____________
Proposed temporary route:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Reason for detour: ___________________________________________________________________________________________
Condi ons:
1. The municipality shall accept full responsibility for the use of the local roads and streets on the temporary rou ng of the
County Trunk Highway and it shall make no claim against the county by reason of their use, and shall indemnify the county,
its agents, officers and employees, against any and all loss, damages and costs or expenses which the county may sustain,
incur or be required to pay by reason of any person or persons suffering personal injury, death or property loss resul ng
from closure of the County Trunk Highway or from crea on, use or maintenance of the detour.
2. The municipality shall minimize as prac cable the dura on of the closure of the County Trunk Highway, including providing
for assembly and dispersal of parades in areas removed from the County Trunk Highway.
3. Applicant will erect, maintain, and remove all traffic control devices needed to affect the closure.
4. Acceptance of oversight approved by municipality.
_______________________________________
__________________________
________________
 
Signature of Authorized Municipal Official 
                  Title 
 
 
 
     Date 
The above municipality hereby requests permission to close the marked route as described, during which me the municipality
will provide a temporary route for county trunk highway traffic as designated in this applica on. The municipality agrees to and
will abide by the condi ons listed above, which is made by the undersigned municipal official under proper authority to act on
behalf of the municipality represented above.
_______________________________________
__________________________
________________
 
Signature of Applicant 
                   
 
 Title (if applicable)  
 
     Date 
THIS SECTION IS TO BE COMPLETED BY THE HIGHWAY DEPARTMENT
Permit Applica on Approved / Denied — ⃝ Approved
⃝ Denied
If approved, expira on date of permit: ______________
Special Provisions: __________________________________________________________________________________________
__________________________________________________________________________________________________________
___________________________________________
_________________________________
________________
Signature of Authorized Representa ve
Title
Date
Washington County Highway Department — Highway Commissioner: Sco M. Schmidt, PE, PLS
ADDRESS: 900 Lang Street, West Bend, WI 53090‐2666 ▪ PHONE: (262) 335‐4435 ▪ FAX: (262) 335‐4439 ▪ EMAIL: webhwy@co.washington.wi.us

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