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4 f <br /> O'tk.l�,� <br /> �`S�EkI3� <br /> Y .\ <br /> SPECIAL EVENT APPLICATION <br /> REVIEW FORM <br /> .......... <br /> DPW <br /> Name of Event American Lung Association Autumn Esc a a Bike Trek Date of Event 9 27 15 <br /> Approved x Denied <br /> Printed Name/Title Catherine Laurent DPW Director <br /> Date r <br /> Signature <br /> Fee for use? No x� Yes Amou nt <br /> Circle all requirements that apply: <br /> Portable Toilets Trash/Recyclingosal Parking <br /> Disposal <br /> Electricity Safety Lighting Route Safety/Signage <br /> Additional comments/requirements/instructions: <br />