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<br />650.050-10 <br />ENVIRONMEN lilt ,,-I,IINIIGE"'ENI <br />OliO., <br />P.lgIl3of-1 <br /> <br />APPLICANT ASSURANCES: The person preparing tllis Applicalion should initial each of the following to indicate that <br />the Application is complete. <br /> <br />_ If Applicant is a local Highway Beautification Council, evidence of local government approval of this application is <br />attached. (Resalution #1) <br /> <br />_ The local governing body agrees to execute necessary agreements that will include tile details 01 the <br />responsibilities of both the Department and the local gavernment appropriate to this project if a grant is awarded. <br />(Resolution #2) <br /> <br />The Applicatian is being transmitted to the District Highway Beautification Council Grant Coordinator having <br />jurisdiction over the state highway on whicll the beautification project is proposed. <br /> <br />_ All supporting documents are attached. <br /> <br />The project will meet all the Department of Transportation requirements for safely pursuant ta Rule 14.40.003, as <br />related ta the placement af planl materials within the right-of-way, line of sight obstructians, and sight distance. <br /> <br />_ The local governing body understands the attributes ta be used by the Highway Beautification Council ta <br />prioritize all projects (lis led in the last section of this form), and has addressed each attribute to the maximum extent <br />possible. <br /> <br />Tlw undersigned, hereby certifies that ail requirements of the grant program are understood, and that ali <br />information provided with this grant application is true and correct, and represents the desires of the local <br />government entity where lhe proiect wili be installed. <br /> <br />Sign81ure: <br /> <br />Dale: <br /> <br />Title: <br /> <br />END OF APPLICANT SECTION <br />