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COUNTY DEPARTMENT OF TRANSPORTATION SPECIAL EVENT WAIVER FORM Permit No. AHApplication is made by the undersigned to participate in the following activity conducted within the Highway right-of-way. Activity or Event: Adopt a Highway (litter control) Highway: Location (in or near): From: To: TO BE FILLED OUT BY ADOPT A HIGHWAY COORDINATOR ONLY Date (Permit period): HOLD HARMLESS CLAUSE The permittee, or, where the permittee is a minor, (12 -18 years of age), his/her parent or guardian sha.

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