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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?