Application And Permit For Use Of City Of Walker Right Of Way
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1ADOPT-A-ROAD
PERMIT
PERMIT NO._________
APPLICATION AND PERMIT FOR USE OF
CITY OF WALKER RIGHT OF WAY
City of Walker, 4243 Remembrance Rd. N.W.
Walker, MI 49544, 616-791-6854
APPLICANT (ORGANIZATION):
ADDRESS:
CITY:
STATE/ZIPCODE:
CONTACT PERSON:
DAY PHONE NO.: (
)
EVENING PHONE NO.: (
)
ROAD NAME:
FROM:
TO:
END DATE:
START DATE:
PURPOSE: ADOPT-A-ROAD
PROGRAM FOR LITTER PICKUP
NAME TO APPEAR ON SIGN:
APPLICANT/AUTHORIZED AGENT
DATE:
(SIGNATURE):
(Agrees to All the Conditions
of the Application)
DO NOT WRITE BELOW THIS LINE
APPROVED BY:
DATE APPROVED:
DEPT. OF PUBLIC WORKS
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