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r <br /> SPECIAL EVENT APPLICATION <br /> REVIEW FORM <br /> DPW <br /> Name of Event Community Health Center 5K Fun Run walk Date of Event 8/13 19 <br /> Approved X Denied <br /> Printed Name/Title Catherine Laurent DPW Director <br /> Signature <br /> Date <br /> Fee for use? Na 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/requirements/instructions: <br /> If water stations are provided along route lease pick up anV associated litter after the <br /> race. <br />