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Name of Soad sLocation :Sub j ect1* Type of existingconstruction) i2* Improvement involved j3- Scheme requested byk« Scheme proposed by5« Scheme agreed orapproved by6. Is resumption required* i 7»!Road covered by Statutory/0»D* Plan; 8» Is there an item in P.I*Programme for this road9* Any traffic signalproposal10. Any proposed bus shelterat this site11* Any drainage improvementrequired12. Any sewer duplicationproposalIJ. Estimated cost sIk. Remarks sHighways ( ) DivisionCheck List for Possible Itemsin Minor Improvement.InformationConcrete. Flexible* Concretewith bituminous surface.Provision of bus bay or lay-by*Widening to approved reserve.Superelevation® Widening on bend*Junction improvement*Widening of narrow bridge.Provision of car park®Provision of footpath*C E T E /C S 0 /T (P L 0 )G.H.E./tt.' NoOn Crown landYesNoNoNoNoNoNOIt has/has not been clearedwith C.L* & 3*0. (refers*) inYes* Plan No* refers.Yes. Itemin CategoryYes f in T«E. f s 19 /programme . Anticipatedimplementation date /19YesYes* Manhole. Gully, Stormwaterdrain* Sewer.Yes* Drg* No* refers*Anticipated implementationdate /1QWorks can start immediately/weeks after approval*¥.5Appendix(July 77)Initial& DatePrepared byEngineer/Asst * Engineer/ A9

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