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APPLICATION FOR USE OF <br />PUBLIC RIGHT-OF-WAY FOR <br />The Board of Public Works must have FOUR (4) weeks prior notice of the <br />Sponsor: � ! // jG cif /�/W ��/�?or 491 Submitted By: <br />Address: 5%2 &Aegol; /- P CT. <br />City: Ac 4 Ui I1� <br />State: Zip: aZ9806 Phone: <br />ROO - z. T 3 - / S- 30 <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 />CHANGE YOUR ROUTE FOR SAFETY PURPOSES <br />Event name: <br />ofle 4 r- /<Cpc <br />a The Board of Public Works must have FOUR (4) weeks prior notice before event occurs <br />©— All certificates of insurance, pre -paid costs, maps, and any other applicable information requested <br />or required by the Board of Public Works have been provided with this application <br />❑- The event shall be held on J3_L(" : 2�(It 201-7 and no other date <br />0 Registration time for the event starts at 00 a.m./p.m. <br />❑v" Starting time of the procession is //—o� <br />a.m./p.m. <br />❑' Estimated completion time is / PM a.m./p.m. <br />This event involves the use of the following roadways <br />[� This event involves City streets <br />This event involves County roads <br />[ This event involves State highways <br />[� I understand that I must arrange a meeting with all affected governmental agencies to <br />organize the above event (Call Marcia Qualls, Customer Service Manager, 235-5939 <br />to organize meeting) <br />❑ This event involves the use of the sidewalk <br />❑ Participants must stay on the sidewalk and obey all traffic laws. <br />This event is a(locaj)egional/national event (Please circle the appropriate event type) <br />This event will be coordinated with the property owner/business where staging will take place <br />Updated 6/25/12 <br />