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Adopt-A-Road Program

Litter Control Application

 

Applicant Group's Name


Contact Person


Street Address


City


Zip Code


Day Phone


E-mail


Alternate Contact Person


Street Address


City


Zip Code


Day Phone


E-mail


Adopted Road Name


General description of road to be Adopted:

From


To


Anticipated frequency of cleaning with required minimum of SIX MONTHS:

Weekly


Bi-Weekly


Monthly


Bi-Monthly


Anticipated number of participants at any cleanup?