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APPLICATION FOR USE <br />PUBLIC RIGHT-OF-WAY FOR PR+ <br />The Board of Public Works must have FOUR (4) we( <br />sponsor: �� SubmittedBy: <br />p t, f y: <br />Address: <br />City:Kil;„: �yttie d� <br />State: Gip: �' Phone: µ `' , <br />1,�µ , / <br />Email: �; „ w.�. , a r5l j c (,.,) Nix" <br />Sponsor may use the public right-of-way described as (describe route and attach snap) <br />PLEASE NOTE: THE SOUTH BENDS POLICE DEPARTMENT RESERVES THE RIGHT TO <br />HAN E YOUR ROUTE FOR SAFETY PURPOSES <br />Event name: VA IG �� �C �.. - <br />❑ The Board of Public Works must have FOUR (4) weeks prior notice before event occurs <br />LZ All certificates of insurance, pre -paid costs, amps, and any other applicable information requested <br />or required by the Board of Public Works have been provided with this application <br />❑'i The event shall be held on z'o 1 + 1. , 20 and no other date <br />❑ Registration time for the event starts at ''p.m. <br />❑ Starting time of the procession is ) X 0 6 a.m. m. <br />❑ Estimated completion time is :310a.m. " .m <br />This event involves the use of the following roadways <br />❑ This event involves closure of City residential streets <br />R This event involves County roads <br />This event involves State highways <br />❑ This event involves use of a park (Must obtain permission from Park Board) <br />KI I understand that I must arrange a meeting with all affected governmental agencies to <br />organize the above event (Call Marcia (walls, Customer Service Manager, 235-599 <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 oca regional/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 08/2017 2 <br />