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Nebraska <br />#60'R <br />partment of Roads <br />. y 1111111�- <br />Applicant: (Name and Address) <br />F <br />r <br />21'� S, ►�'rhs� <br />L <br />and <br />BannerPermi <br />Date: Z Z 3� 1 S <br />Phone: b2 -Llu,-L,19q <br />Fax No.: bo 42t- L/ 1 9,5 <br />_J Email: brwhydc'OC I . Ucii(.ncLAS <br />Purpose of Application: <br />It is the City or Village's desire to obtain permission from the Nebraska Department of Roads (NDOR) to install banners <br />within the state highway right of way during calendar year 24)4. The banners erected will be for the following <br />purposes:, <br />1. to announce plans for upcoming events, or, <br />2. to promote community pride and spirit, or, <br />3. to serve as a non -message decoration. <br />NDOR Authority: <br />Neb. Rev. Stat. 39-1359 provides the Department authority to control the use or occupancy of state highway right-of- <br />way. Section 39-1359 states as follows: "The rights-of-way acquired by the department shall be held inviolate for state <br />highway and departmental purposes and no physical or functional encroachments, structures, or uses shall be <br />permitted within such right-of-way limits, except by written consent of the department." <br />Criteria for Placement, Restrictions and Limitations, and Permit Requirements: <br />The City or Village affirms and declares that they accept and will abide by the NDOR Banner Policy, dated July 1, 2005. <br />The NDOR, by approving the City or Village's application, does so on the basis of the City or Village's affirmation and <br />declaration. <br />Cancellation/Revocation of Permit: <br />The permit issued by the NDOR may be cancelled or revoked when the NDOR has actual knowledge that the City or <br />Village has failed to comply with the provisions of this permit. In the event that the City or Village has failed to remove <br />any banners upon request by the NDOR, the NDOR reserves the right to remove any or all banners at the expense of <br />the Village or City. <br />i� c �-c,► Of h1 c r'r <br />City or Village <br />C1 �c1 CterX <br />Title of Representative <br />Zftrid� INheJe( <br />By (Printed Name) <br />1-,64 An5_�_7 <br />Signature <br />DR Form 207, November 2011 <br />Nebraska Department of Roads <br />District Engineer Approval <br />Date <br />