<p> Illinois Major Bridge Program Application</p><p>Bridge IDOT County: Name: District: Structure City: Number(s): Facility Facility/Fea Carried: ture Owner: Jurisdiction Yes No al Type of Rehab Replace Date of Work: Last Sufficiency Number of Functional Rating Lanes: Class Load Yes No List the Posted: load ADT (from ADTT: ADT’: ADT Year: SI&A (Do not use Future/Projected ADT or AADT counts here. Use the last official recorded counts.)</p><p>FY REQUEST (in dollars) Entire Major Major Bridge Request (PE,Project CE, Bridge(CE, (CE, Construction) ROW, Constructio Total Cost Federal Share (80%) Non- Federal Matching (20%) *Cost estimate of bridge and bridge approach work to be used in rating factor calculation.</p><p>Describe construction activity planned (rehabilitation of substructure, superstructure, deck, main span, etc. or total replacement) below and attach a current briefing about the entire project:</p><p>Special Consideration: </p><p>Contact Person Information Name: Phone: Street City: Address: Printed 4/4/2018 OPP 2171 (Rev. 07/24/14) E-mail:</p><p>Printed 4/4/2018 OPP 2171 (Rev. 07/24/14)</p>