Keep Polk County Beautiful
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Keep Polk County Beautiful and the Polk County Board of County Commissioners will work with the adopting group to determine the specific section of County road available. Roadways with a lack of sufficiently wide right-of-way will not be considered.
(Please print or type)
Name of Organization, Business or interested group: _____________________________________ Date: ______________
Mailing Address: ___________________________________________________
City, Zip Code: _____________________________________________________
President, Chairperson, etc: ___________________________________________
Name of Contact Person: _____________________________________________ Day Phone No.: ___________________
Mailing Address: ___________________________________________________ Evening Phone: ___________________
City, Zip Code: ____________________________________________________
In an effort to be a more “green” organization, we are hoping to move towards electronic versions of these forms. Please submit your e-mail address for future correspondence and updates. Of course, we understand if you do not have access to e-mail programs, and will be happy to continue our correspondence via phone and mail.
E-Mail Address: ___________________________________________________
Anticipated number of members participating in the program: _______________
Street section(s) you are interested in adopting: Assigned
1. ___________________________________________________ (
2. ___________________________________________________ (
3. ___________________________________________________ (
4. _________________________________________________________ (
Mail this form to: Keep Polk County Beautiful, Inc.
P.O. Box 123
Eagle Lake, FL 33839
Phone: (863) 875-8911
kpcbeautiful@
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Application Form Adopt-A-Road Program
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