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APPLICATION <br />FOR USE OF AND BLOCKING OF ACCESS TO PUBLIC <br />RIGHT-OF-WAY FOR A RESIDENTIAL BLOCK PARTY <br />The Board of Public Works must have four (4) weeks prior notice of th, <br />A NON-REFUNDABLE APPLICATION FEE OF $50.0�O�, IN THE FORM Of <br />CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE <br />INCLUDED WITH APPLICATION. <br />Applicant Name: <br />Organization: <br />city: <br />zip 11(flol <br />Address: <br />X -t 7) V. fil e I C I <br />Phone: <br />Email: t ep c�rvun. elelko <br />Sg,cQnda:ry Contact <br />-�\( t V <br />Address: 17 N X - i,31r2Yb r- 6-e- Ccl- 51 <br />City: State: <br />Phone. Email: <br />) �-useo�f�C' <br />4oPlublic Morks, <br />This application is made to the City of South Bend, Indiana, Board, for t <br />the specified ublic right,-of-wa by,Applicant for the holding of the hereinafter described event: <br />'Event Name <br />t <br />V') <br />Name of <br />Street Closure <br />Street <br />�U L;DV-h c, I d <br />From <br />Kflitr <br />TO <br />ka�-c,, attf <br />Date of Event <br />Time <br />Setup <br />dM,m, <br />Flp,m, <br />Start <br />a. p,rn, <br />I <br />End <br />oe, <br />(a- <br />rn. Z <br />Time <br />Timel <br />P,m. <br />Approximate Number of <br />Attendees <br />Please answer the following appropriately: . <br />........ <br />• This event will be open to residents outside the immediate <br />Yes <br />El <br />No <br />neighborhood. <br />• All residents on the affected block have been notified and invited. A <br />Yes <br />El <br />No <br />copy of the flyer distributed is included, <br />• There is/are resident(s) affected by the event that may need ADA <br />Yes <br />-M <br />No <br />transportation assistance to their residence. <br />• This event will have music (live or other). <br />Yes <br />[] <br />No <br />* Payment of $50.00 fee payable to City of South Bend included <br />r <br />Yes <br />E] <br />No <br />Updated 08/2017 <br />