WALTHAM TRAFFIC COMMISSION

155 LEXINGTON STREET

WALTHAM, MA 02452

(781) 314-3580

REQUEST FOR TRAFFIC IMPROVEMENTS OR CHANGE IN TRAFFIC REGULATIONS

TYPE: (Traffic Regulation, Sign, Safety Island, Signal, Speed, Parking, Etc.):

________________________________________________________________________________________

LOCATION:

________________________________________________________________________________________

Describe briefly the problem to be corrected, any suggestions you may have, and the dates of any accidents, which may have occurred at this location and other pertinent data. Use the back of this sheet for further discussion or for a DIAGRAM of the location:

Name_____________________________________________________

(Printed)

Signed________________________________________________________________Date___________________________

Address__________________________________________________Phone__________________________

(Signatures of Co-Petitioners on reverse side)

To print out this form click here