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Sep.16.2016 2:48PM <br />AUTHORIZATION FOR USE OF <br />PUBLIC RIGHT-OF-WAY FOR EVENT <br />@ 0110a <br />The Board of Public Works must have FOUR (4) weeks prior notice of the event. <br />Marcia Qualls should be contacted FIVE TO SIX (5-6) weeks prior to the event. <br />❑ I have met with Marcia Qualls, at 235-5939 or m ualls southbendin. ov, and enclosed this <br />signed Authorization Form with my application to the Board of Works, for authorization of the <br />proposed date and location/route of event. <br />Event name: W —gyp y(t( 414W! <br />Sponsor: k6lSubmitted By: k6UihA <br />Address: tjjj.4 �'M ' <br />City: (:Kk wdakil <br />State: 1hUpwt: Zip; qi Phone: Zip <br />Email: p eha etl1�419 70rI- 15t{� <br />I have met with the applicant and confirmed the time, date, and route requested for this event <br />will not conflict with any previous applications. <br />This event is approved for <br />20 . beginning at a.m./p.m and ending <br />at _ a.m./p.m. at the approved location: <br />Marcia A. Qualls <br />RETURN FORM TO: <br />Board of Public Works <br />1316 County -City Building <br />227 West Jefferson Boulevard <br />South Bend, IN 46601 <br />Phone: (574) 235-9251 0 Fax; (574) 235.9171 . E Mail: It Niowks aft, southbendityaov <br />n <br />