Adopt-A-Highway Program

APPLICATION FOR

"ADOPT-A-HIGHWAY" SIGNS

(for use ONLY by municipal officials)

Date_______________

In order to clean up the environment and enhance the appearance of roadsides, the municipality of

____________________ has created its own Adopt-A-Highway (AAH) Program and requests permission to erect up to four "Adopt-a-Highway" sign assemblies at the following locations on State, State Aid, or local roads, pursuant to 23MRSA§1117 and Rule 17-229-207:

Route # or Road/Street Name Exact Location
(include diagram)

1)___________________________________________

2)___________________________________________

3)___________________________________________

4)___________________________________________

Each municipality is allowed up to four sign assemblies with a total area of up to 50 sq. ft. each. Each participating organization can place an individual sign up to 4 sq. ft. in area on the full assembly.

It is understood that all AAH signs are considered "off-premise" signs and any erected on ANY public road are illegal and subject to removal until MDOT approval is received through this application.

The undersigned hereby requests permission for the erection of AAH signs along these roadways.

__________________________________ _______________________________
Municipal Official Date

__________________________________
Title