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. III i I <br />VIR-) 9MYZATMaLli ta W <br />The Board of Public Works must have FOUR (4) weeks prior notice of the <br />Sponsor: <br />Address: <br />? City: <br />State: i 4 <br />A"eP._'1_T_)Phone: <br />Email: e <br />Sponsor may use the public right-of-way described as (describe rout(; <br />attach map) <br />PLEASE NOTE - THE SOUTH BEND POLICE DEPARTMENT RE, SERVES THE RIGHT TO <br />CHANGE YOUR ROUTE FOR SAFETY PURPOSES <br />Event name: d&Z Z�117 ZA4_�dY-L k4PA— �K�/ y1olk-e e_ <br />El The Board of Public Works must have FOUR (4) weeks prior doticebefore 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 />EJ The event shall be held owv_/10� �__ I 20Lf and no other date <br />El Registration time for the event starts atffP(a './P.M. <br />El Starting time of the procession is/ 7,�P&Jp.m. <br />Ej Estimated completion time is a.m m. 1�j <br />This event involves the use of the. following roadways <br />XThis event involves closure of City residential streets <br />El This event involves County roads <br />El This event involves State highways <br />This event involVes use of a park (Must obtain permission from Park Board) <br />El 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 />0- This event involves the use of the sidewalk <br />[I Participants must stay on the sidewalk and obey all traffic laws. <br />Pq This event I I El This event W, <br />event (Please circle the appropriate event type) <br />coordinated with the property owner/business where staging will take place <br />Updated 08/2017 2 <br />