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Sep, 16, 2016 2:47PM <br />APPLICATION FOR USE OF <br />PUBLIC RIGHT -OF -WAX FOR PROCESSIONS <br />No <br />The Board of Public Works must have FOUR (4) weeks prior notice of the <br />❑ I have met with Marcia Qualls, at 235-5939 or m ualls southbendin. ov, and enclosed the signed <br />Authorization Form with my application to the Board of Works for authorization of the proposed date and <br />route of event. <br />Sponsor: -c.l eitke � 1 p — Submitted By: �J (TGhA ^� <br />Address: (r 5,2+ ✓� <br />City: �AiLuRL. <br />u tic. <br />State: 6 Zip: V 4 Phone: 20 — 42. p — g dl <br />Email. ayhQ 19 412- O <br />Sponsor may use the public right-of-way described as: (describe route and attach map) <br />PLEASE NOTE: THE SOUTH BEND POLICE DEPARTMENT RESERVES THE RIGHT TO <br />CHANGES YOUR ROUTE FOR SAFETY PURPOSES <br />Event name: 4e WA 49 fiO— Z eN,M46 <br />❑ The Board of Public Works must have FOUR (4) weeks prior notice before event occurs <br />[r All pre -paid costs, maps, flyers, event description, and any other applicable information requested <br />or required shall be submitted to the Board of Public Works with this application. <br />Q Certificate of Insurance shall be submitted to the Board of Public Works no later than two (2) <br />weeks prior to the date of this event. The Board reserves the right to pull the permit if a certificate <br />of insurance is not received on time. <br />❑ The event shall be held on A .�i ' 201jo and no other date <br />❑ Registration time for the event starts at 1:00 a.m./—m. <br />❑ Starting time of the procession is 215 a.m./Im <br />❑ Estimated completion time is 21PQ a.m./gym. <br />❑ Estimated number of participants is A& <br />This event involves the use of the following right-of-ways: <br />❑ This event involves City streets <br />❑ This event involves County roads <br />❑ This event involves State highways <br />[r]' This event involves use of a park (Must obtain permission from Park Board) <br />[+ This event involves the use of the sidewalk. Participants must stay on the sidewalk and obey all <br />traffic laws. <br />Updated 4/06/16 <br />