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CUYAHOGA COUNTY <br />DEPARTMENT OF PUBLIC WORKS <br />2079 East 91h Street, 5th Floor . Cleveland Ohio 44115 <br />(216) 348-3800 <br />COUNTY ROAD 50/50 PROGRAM FUNDING APPLICATION <br />APPLICANT INFORMATION: <br />MUNICIPALITY: <br />PREFERRED FUNDING YEAR: ❑ 2021 ❑ 2022 <br />CONTACT NAME: <br />TITLE: <br />EMAIL: <br />PHONE: <br />PROJECT INFORMATION: <br />COUNTY ROAD: <br />PROJECT DESCRIPTION: <br />PROJECT LIMITS: <br />PROJECT LENGTH (FT): <br />LAST YEAR OF RESURFACING: <br />PAVEMENT WIDTH (FT): <br />NUMBER OF LANES: <br />AVERAGE DAILY TRAFFIC (ADT): <br />PAVEMENT CONDITION RATING (PCR) USING ODOT RATING SYSTEM: <br />FINANCIAL INFORMATION: <br />rESTIMATED CONSTRUCTION COST: <br />LIST ALL OTHER FUNDING SOURCES AND RESPECTIVE AMOUNTS: <br />REQUIRED DOCUMENTATION AND SIGNATURE: I <br />❑ PCR MAP/ODOT PCR FORM I ❑ COST ESTIMATE ❑ CONSTRUCTION SCHEDULE <br />APPLICANT SIGNATURE (WET OR ELECTRONIC): I DATE: <br />