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<br />AI1111AC',ATION F:
<br />WOR USE OEM`, �1ND IMOCKING Of' A( li,SS TO 'I'1II!: I'L1I LK,
<br />:RftAi'1'••UF-WAV FOIL NARTIIs.'S
<br />'I'11e Board o.f'I'1lblic WoE"fi;; nlEist have Vf.)i.lIZ (4) weeks prior notice ol•(Ile cvcll(,
<br />A NUN-•12leV11NI.lrllil'_E AI'L'1.,1CA'I'ION leK11, 0le$125.IH1, 1N'I•III- R)RM 0 k A C'IilRTll ll.l)
<br />C'1II?C:`1C 012 1vl0NU OR1)V:R, 11AYAIII,1 •1•C) `I'I II; ('i'1'Y OV SC)lI'1'1'I III "sNl), [v1f1S`I' 131?
<br />IN('I,1.1DT,'l) WIT] I. AI'111,1C'ATION.
<br />Fcc, Paid
<br />rJ ,()11_l�f Applicant Nllnlc: �4......t�;.1_Vlt�c' ..�..iiit.•�[:1.1.4 {�� L)�...:. �(�)`.�,1"_ ..GlJiliLj
<br />Address: - �X
<br />1.11 .1( t1\ f:.€ j . C.Ety x.;��t 1 ...) .k};(:!(L;: ((�4 zip:
<br />1"•mail
<br />This applicadon is made to the C.:ity of'Sou(h Reuel, Indiana, Board of'I'nblic \Yorks, kw dw use of 111c
<br />SI)Ceificd pLit) lic, 1-ig11t-0f' way by AppIica111 lbr (Ilia holdi11p, of (llc Iicl-c;ill'illcr dcscribc.d cvr.11(:
<br />,_lL1 o "_1I . 0'1"` 11.�_
<br />(x ..(D.1
<br />(tJi 4CIIt1U
<br />ArcaiRfo a )
<br />hll'cef Closure Nlri„coCSiracl ' , 1 7�CC t.1
<br />1� �( 111�ILTI l
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<br />° � t4((ti I v11'i
<br />�Y lutl :7 71't :c:" l 1_`.t
<br />Front
<br />4�1....-1 L14C> 111f ._:{'>ii:
<br />LU
<br />. (1�I� ', 41Vr, 4C�r1c c.:,111,
<br />Daie of li,vi of }(_)�
<br />f �j
<br />20
<br />Time: ftc,f;islralioll/Sclilll
<br />..... __. ❑ pm). Starr
<br />) C) _...... (I 1T.nr,
<br />liild
<br />Apprl)•1'i11111EC Nli1111)cl• ilt•r1(tciiclecs _.4l��t:,l
<br />Answer (lice li)ilowiul; ;ipllrc)priafx�ly;
<br />I . This event will have. music (live or olher).
<br />�,!�� VCS
<br />o
<br />il. I understand the Noiso Ord illance dcnribcd in die,, A
<br />}ri;S
<br />2., ECctluircd fnfbi-m Ilion to Accolllpmiy Application
<br />.t. C alilied (-.hec]h oi- Molley Ordel" En (hi: Allmullt ol'yi 12.5,00, or:
<br />11. I'or Cell i fied Nollprolft Organizations: Copiv6 of* tlie 501(c)(.3)
<br />1111unlal Itevcuue lsxeiriptioll StlltuS Docuulell( and n Current copy of
<br />Forill 990 of Forill 990.+Y. arc ineludod Willi Ellis application' alld
<br />�; J' ),vs
<br />No
<br />addi(Eollillly filed will) (lle (Alice of the (.1(y Clerk, d", fluor, C.'oullly-
<br />City Building, 227 W. .lef'fcr:soii 131vd,, South Rend , llulialla.
<br />Cal al ITISln'MICC
<br />d. Maim, clr'atvirigs Auld :sc(up plall ol,dic ar'ca
<br />�._ � Yes �,
<br />_� i"10
<br />e, A copy ol'a flyer or clone' hallger dial 11'r1S boon disirlbll(od to '111
<br />01'e- deed property owilers.
<br />:1.
<br />�......� 1 a' [
<br />No
<br />,I. Phis cvelit involves C'il•y slrcel's
<br />I ', Yes
<br />1�o
<br />1), This evcl,t illvolvc, CM111ty roads
<br />[mm� Yc,ti ..
<br />No
<br />v, Phis event involves State highways
<br />l',n
<br />Updated 812017
<br />1
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