This form is filled out by the Bridge Owners only (NJDOT, Agencies or their representatives, County Admin, or Township/Municipal/Local Manager). Submit the form to Pontis.Submission@dot.nj.gov and copy to County.CulvertInsp@dot.nj.gov as an e-mail attachment with the subject “CombIS: Add/Delete Asset”.	
*Required Fields
	
Bridge Owner*:	     		
Location (Township/ Municipality/Borough):	     		
	
Information of Person Requesting Asset:	
First Name*:	     	Last Name*:	     		
E-mail*:	     		
Office Phone:	     	Mobile Phone:	     		
Name of Requesting Dept./Agency/Consult.*:	     	Group*:	     		
	
Asset Type*:	
This information is for (check ONE): 	 NBIS Bridge     State Minor Bridge   Sign Structure   HMLP    Dams	
	 County Minor Bridge              Municipal/Local Minor Bridge      	
	 Other	     		
	
This information is for (Check all that apply): 	 Add New Asset [  Structure No. Requested]          Delete Existing Asset      	
							
State Structure Number* (NBI Item 8):	     	Owner* 
(NBI Item 22):	     	Federal Report* (State Item CP):	     		
State Structure Name* (State Item AB):	     		
County Code*
(NBI Item 3):	     	Inventory Route* 
(State Item AA):	     		
County Str. No.*
(CombIS M82):	     	Structure Length* 
(NBI Item 49):	     		
Funding Category* (NHPP, STP-On, STP-Off, Other):	     	Effective CombIS Width 
(CombIS Item M141):	     		
Cycle of Inspection (State Item CI):	     	Consultant  
(State Item CM):	     		
Latitude
(CombIS Item M84):	      degrees	Longitude
(CombIS Item M85):	      degrees		
	
Reason for Creating/Deleting Asset (Specify):
     	
Comments: