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f 1 kWeIMZ <br /> E • fit <br /> Z�n <br /> SPECIAL EVENT APPLICATION <br /> REVIEW FORM <br /> DPW <br /> Name of Event Community Health center 5K Fun Run Walk Date of Event 8/13Z19 <br /> Approved X Denied <br /> ,Printed Name/Title Catherine Laurent DPW Director <br /> Signature <br /> Date <br /> Fee for use No X Yes Amount <br /> Circle all requirements that apply: <br /> Portable Toilets Trash/Recycling Disposal Parking <br /> Electricity Safety Lighting Route Safety/Signage <br /> Additional comments/req uirements/instructions: <br /> If water stations are rovided along route lease pick up anv associated litter after the <br /> ra ce. <br />