Appendix - Florida Scenic Highways

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATIONDESIGNATION APPLICATIONFlorida Scenic Highways ProgramFORM 650-050-05ENVIRONMENTAL MANAGEMENTOGC - 08/96Applicant seeking National Designation?Yes NoSubmission of this Designation Application form and its accompanying Corridor Management Plan verifies that designation as a FloridaScenic Highway is being sought for the corridor identified below. Please prepare and submit this application to the District Scenic HighwaysCoordinator according to the guidance provided in Section 3.2 Designation Application and CMP Format.Roadway/Route Number and Name - Provide the state and US road number (if applicable) and the local or any regionally recognized namefor the roadway.Scenic Highway Name - Provide the scenic highway name to be used in any promotional activities.Date of Eligibility - Provide the date of the Letter of Eligibility.Corridor Advocacy Group - Provide the following information regarding the CAG chairperson.CAG ChairpersonAddressPhone NumberCorridor Management EntityCME Chairperson or EquivalentAddressPhone NumberWe verify that all information stated on this form and/or included in the Corridor Management Plan are, to the best of our knowledge,true representations of the corridor and the resources for which designation as a Florida Scenic Highway is being sought.X DateCorridor Advocacy Group ChairpersonX DateCorridor Management Entity ChairpersonX DateLocal General Purpose Government RepresentativeX DateLocal General Purpose Government RepresentativeAdditional Information - On an attached sheet, provide updated names, titles, addresses and phone numbers for the following:1) CAG Chairperson, Vice-Chairperson, other officers/committee heads and remaining membership and 2) additional local general purposegovernment representatives with signature.RECYCLED PAPER