Street Closure - Mary Olen - Laserfiche WebLink

Home Browse Search

APPLICATION FOR USE OF AND BLOCKING OF ACCESS TO PUBLIC RIGHT-OF-WAY FOR A RESIDENTIAL BLOCK PARTY The Board of Public Works must have four (4) weeks prior notice of the event, A NON-REFUNDABLE APPLICATION FEE OF $50.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE INCLUDED WITH APPLICATION. Applicant Name: I hwy 4e,�IQEW Organization: City: State: Zip Address: Phone: Email: Secondary Contact Address: Vs A)o r4A P+' City: U'Ve_16 State'. Phone: Email, This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the specified ublic right-of-way by Applicant for the holding of the hereinafter described event: Event Name Name of Street Street Closure From 7_6 A/ To Date of Event -71' L91 120 1 Time Setrap Ela,m, 'P.m. Start e Elam, 2P,m, En I Elam. (0 3 &��n Time 00 Time P.M, Approximate Number of Attendees Please answer the following appropriately: • This event will be open to residents outside the immediate ❑ yes No neighborhood. • All residents on the affected block have been notified and invited. A EZ Yes E] No copy of the flyer distributed is included. I L,,,"" • There is/are resident(s) affected by the event that may need ADA ❑ Yes No transportation assistance to their residence. / I/ • This event will have music (live or other). El /Yes [0 No Payment of $50.00 foe payable to City of South Bend included L_V1 Yes F❑-1 No 10 Updated t}8/2017