Comprehensive Annual Banner Application and Banner Permit
Applicant: (Name and Address)	Date:
Phone:
Fax No.:
Email:

Purpose of Application: It is the City or Village’s desire to obtain permission from the Nebraska Department of Transportation (NDOT) to install banners within the state highway right of way during calendar year . The banners erected will be for the following purposes: to announce plans for upcoming events, or, to promote community pride and spirit, or, to serve as a non-message decoration.

NDOR Authority: Neb. Rev. Stat. 39-1359 provides the Department authority to control the use or occupancy of state highway right-of-way. Section 39-1359 states as follows: “The rightsofway acquired by the department shall be held inviolate for state highway and departmental purposes and no physical or functional encroachments, structures, or uses shall be permitted within such right-of-way limits, except by written consent of the department.”

Criteria for Placement, Restrictions and Limitations, and Permit Requirements: The City or Village affirms and declares that they accept and will abide by the NDOT Banner Policy, dated July 1, 2005. The NDOT, by approving the City or Village’s application, does so on the basis of the City or Village’s affirmation and declaration.

Cancellation/Revocation of Permit: The permit issued by the NDOT may be cancelled or revoked when the NDOT has actual knowledge that the City or Village has failed to comply with the provisions of this permit. In the event that the City or Village has failed to remove any banners upon request by the NDOT, the NDOT reserves the right to remove any or all banners at the expense of the Village or City.

City or Village
Title of Representative
By (Printed Name)	Nebraska Department of Transportation
Signature	District Engineer Approval	Date

NDOT Form 207, July 17