APPLICATION FOR AUTHORITY TO MAKE CHANGES EFFECTIVE ON LESS THAN 30 DAYS NOTICE
To: New Jersey Department of Transportation
Division of Multimodal Services
PO Box 600
Trenton, NJ 08625
___________________________________________________________
(Name of Utility) by (Name of Officer)
Its (Title of Officer) _____ hereby applies for ____ authority to make effective the following rates, N.J.D.O.T. No. ______ on (date) _______ by filing with the Department on _______ days notice. This application is based upon the following special circumstances and conditions:
_________ (Name of Utility)
_________ (Name and title of authorized representative)
N.J. Admin. Code § 16:65-12.9