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Nn /DOT 29222 (8-77) <br />MINNESOTA DEPARTMENT OF TRANSPORTATION <br />PRELIMINARY BIKEWAY GRANT APPLICATION <br />Instructions: <br />1, P /ease type or print in ink (use ball -point pent, except for applicant's signature. <br />2. Directions for mailing on reverse side of yellow copy. <br />3. This preliminary grant application must be submitted by <br />to be considered for F. Y. 19 -1? <br />Preliminary grant application for financial assistance in local bikeway development. <br />(M.S. 1977, Ch. 421) <br />Minnesota Department of Transportation <br />Bureau of Policy and Planning' <br />Office of Environmental Affairs (Bike Program) <br />820 Transportation Building <br />St. Paul, MN 55155 <br />Do Not Write Above This Line <br />Date request received <br />IA Political subdivision responsible for project: <br />NAME <br />Length of <br />segment <br />TITLE <br />ADDRESS <br />Extent of site preparation <br />ADDRESS <br />CITY <br />On road <br />w /barrier <br />ZIP <br />PHONE <br />AREA CODE ( <br />CITY <br />ZIP <br />COUNTY <br />PHONE <br />AREA CODE <br />( <br />1 <br />Person to whom inquiries about the preliminary application <br />should be directed: <br />NAME <br />Length of <br />segment <br />TITLE <br />ADDRESS <br />Extent of site preparation <br />Cost <br />CITY <br />On road <br />w /barrier <br />ZIP <br />PHONE <br />AREA CODE ( <br />1 <br />Project description: label project segments (A, B, C, ... 1 on table below and map. <br />Project Segment <br />Length of <br />segment <br />Width of <br />segment <br />Surface <br />material <br />Extent of site preparation <br />Cost <br />On <br />road <br />On road <br />w /barrier <br />Off <br />road <br />D <br />Location of bikeway project: Attach county and or municipal map showing: <br />• project location in community • scale of map • public access to proposed project • present bikeway system • adjacent land use <br />• identify bike safety problem areas <br />IE] Project justification: Refer to reverse side of white copy for further explanation. <br />Safety: <br />IG <br />Service Area: <br />Land Use: <br />Planning: <br />What endorsement has this proposed project received? (i.e., city board, bike club, ... ) <br />Source of local share funding <br />(l 022 <br />Applicant Signature <br />Title Date <br />