Completion of this form is necessary to accomplish the statutory purpose as outlined in the Illinois Commercial Transportation Law, Section 18c-7401. Failure to provide the requested information may prevent your request from being processed.
Form 3
STATE OF ILLINOIS
ILLINOIS COMMERCE COMMISSION
Petition for permission to make a change in crossing
warning devices, or to install new warning devices,
under 92 Illinois Administrative Code 1535.400(d).
Date: December 15, 2005___
To the Illinois Commerce Commission:
The petitioner (Name of Railroad Company) shows:
(1) That it is a railroad company operating a line of railroad in the State of Illinois.(2) That petitioner proposes and hereby makes application for authority to make a major change in crossing warning devices, or to install new warning devices, under 92 Illinois Administrative Code 1535.400(d) adopted by this Commission.(3) That the location of the crossing, the nature of existing warning devices and proposed warning devices, and other pertinent facts in connection therewith, are set forth in the statement attached to and forming part of this petition.(4) That petitioner's reasons and purpose, with reference to its said proposal are: (State reasons and purpose)
_________________________________________________________________
(5) That the facts set forth in this petition and in the statement and plans or plats attached thereto are, all of them, true and correct to the best of petitioner's knowledge and belief. WHEREFORE, the petitioner prays that the Commission will, if deemed desirable by the Commission, set the aforesaid matter for hearing, and that the Commission enter an order or adopt a resolution consenting to and granting authority for the making of the said proposed changes in or additions to crossing warning devices.
(Name of Railroad Company)
________________________________________
By ________________________________________
(Name of Person Submitting Form 3)
(Title of Person - use Enter key for additional lines)
(Phone Number)
__________________________
(Attorney for Petitioner)
__________________________
(Attorney's Address)
(Use Enter key for up to four additional lines.)
Statement, attached to and part of an application for permission to make a major change in crossing warning devices or to install new warning devices, under 92 Ill. Adm. Code 1535.400(d).
Name of Railroad
1. Name of Railroad Company ___________________________________________2. Crossing Number & Railroad Milepost _____(Separate statement should be filed for each crossing)_____3. Village or City _____(Please indicate whether in or near Village/City)_____4. Name of Street or Highway ____________________________________________5. Public Agency Maintaining Highway ___(DOT, County, Township, City)___6. Existing warning devices: _(Give full description. Indicate the hours of any manual warning devices.)___7. Proposed warning devices: _(Give details)_______________________________________________________________________________________
8. Number of main tracks ____________ Other tracks ____________9. Number of passenger train movements:6 a.m. to 6 p.m.______ 6 p.m. to 6 a.m.10. Number of freight train movements:6 a.m. to 6 p.m.______ 6 p.m. to 6 a.m.11. Approximate number of switch movements:6 a.m. to 6 p.m.______ 6 p.m. to 6 a.m.12. Maximum speed of trains at crossing on each track in each direction Track 1 N/E Bound________ mphS/W Bound ________ mph
Track 2 N/E Bound________ mphS/W Bound ________ mph
Track 3 N/E Bound________ mphS/W Bound ________ mph
13. Passenger platforms served by tracks within the limits of track circuits, if any ________14. Where automatic signals or gates are proposed, approximate number of train or engine movements daily that would cause false indications or operation ________________________15. Nature and approximate amount of street or highway traffic over crossing ___________ ___________________________________________________________________
16. In addition to the information listed hereinbefore in Form 3, attach a track plan or plat of the proposed crossing This plan should show: (a) Width and surface of highway. (b) Highway intersections (including private driveways to be so indicated) and location of established highway signs or signals within 100 feet of crossing. (c) Location of tracks, switches and other railroad facilities such as block signals, etc., within limits of track circuits, present and/or proposed (d) Where automatic warning devices are proposed, show proposed location of signals (sidelights, cantilevers, etc., if any). (e) Show the length of each operation track section within the control limits of the crossing warning devices and its function. ADDITIONAL INFORMATION
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VERIFICATION
I, ______ (Name) ______, first being duly sworn upon oath depose and say that I am ______ (Title) _______ of ________ (Railroad Name) ___, an_____ (State) ______ corporation; that I have read the above and foregoing petition by me subscribed and know the contents thereof; that said contents are true in substance and in fact, except as to those matters stated upon information and belief, and as to those, I believe same to be true.
__________________________________________
(Signature above line & Title below line)
Ill. Admin. Code tit. 92 , H, Appendix A, ILLUSTRATION C
Old Illustration A repealed at 11 Ill. Reg. 19027, effective November 15, 1987; new Illustration A adopted at 29 Ill. Reg. 20376, effective December 15, 2005