Jefferson County Class IV AT Route Map, Road Segment Nomination Form

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* 1. Person Submitting Request

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* 2. Your personal email address

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* 3. Your phone number

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* 4. Your address

PROPOSED ROAD SEGMENT

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* 5. Road Name

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* 6. Beginning Intersection

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* 7. Ending Intersection

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* 8. Approximate Length (if known)

WHY SHOULD THIS ROAD SEGMENT BE CONSIDERED FOR INCLUSION ON THE OFFICIAL CLASS IV ATV ROUTE MAP?

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* 9. You must select at least one

*Connection to other proposed ATV routes

*Access to public lands

*Recreation

*Access to services

*Improved route continuity

*Other public benefits

Other (please specify)

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* 10. Additional Comments

Maps or a GIS screenshot identifying the proposed road segment is helpful. You can email those, if availalble, to Matt.Powlison@jeffersoncountyor.gov in addition to filling out this form.