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APPLICATION FORM Contact Name Day Phone Neighborhood Today’s Date Local Address Which neighborhood street(s) are of concern? What traffic problems have you identified affecting the above street(s)? How many property owners did you identify in your petition area? Have you received the minimum required (greater than 60%) signatures on your petition form? Yes No What signature percentage have you received? % Please return the completed application form along with the signed petition forms to: Bay County Traffic Engineering Division 840 W. 11th Street Panama City, Florida 32401 Telephone: (850) 248-8744 For Official Use Only Project Number Date Application Received Date Preliminary Analysis Completed Identified Problems: Exist Perceived Date of Final Analysis Completed Date of Project Presentation to County Manager County Manager Action: Favorable Unfavorable Date of Project Implementation: Project Review Date Project Successful: Yes No FORM A BAY COUNTY SPEED HUMP PROJECT