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Adopt-A-Roadside Program

Adopt-A-Roadside Application Form
__________________________________________________________________
Please provide the following information:

Adopter Name: (May be an individual, family, company, organization, or group)*

Adopter Representative: (Must be at least 21 Years of Age)

Name:*

Address:

City:

State:

Zip Code:

Phone Number:*

E-Mail:*

Proposed Adopted County Roadside: (If a section of County Roadside has already been adopted, it is not eligible for adoption by another Adopter)*

Proposed Limits of Adopted County Roadside: (An adopted roadside section shall be a minimum length of 1/2 mile and have sufficient green areas within the right-of-way to justify the need for litter pickup along the roadside. Adopted road sections on the same road shall abut one another, unless there is more than 1/2 mile distance between adopted sections.)

From:*

To:*

Are "Adopt-A-Roadside" Recognization Signs Requested: (If yes, Saint Louis County will provide one sign at each end of the adopted roadside section. Please note, no "Adopt-A-Roadside" recognition signs will be erected along adopted roadside within a Residential Subdivision.)*
Yes
No

If recognition Signs Are Requested, Please Provide Recognition Verbiage. Use Capital Lettering, Numerals, and Punctuation in the Boxes Shown Below: (Recognition verbiage will be restricted to 1 character per space, 18 characters per line, and two lines per sign. Only Capital lettering, numerals, and punctuation will be permitted. Spaces, dashes, and punctuation will count as characters. No symbols or graphics will be allowed. Verbiage will be centered in each line when signs are fabricated. If only 1 line is used, larger characters will be used. The County reserves the right to edit recognition verbiage.)

Sign Line 1

Sign Line 2

An email will be sent to the email address used in this form to verify the application.

Submit

* Required