Laserfiche WebLink
A-PPLICATION <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 the event, <br />A NON-REFUNDABLE APPLICATION FEE OF $50.00, IN THE FORM OF A CERTIFIED <br />CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE <br />INCLUDED WITH APPLICATION. <br />Applicant Name: <br />Cov Ig 0 /4 <br />Organization: <br />IQ"r 14AT ?W/57-//W A5fCVA7--16'A1 <br />A—ddress: <br />City: <br />State:Zip <br />Phone: <br />Secondary Contact olclml) <br />Address: <br />City: 4 State; . .. ......... . <br />Phone: , 0) Email: <br />This application is made to the, CITY of South Bend, Indiana, Board of Public Works, for the use of <br />the s ecified ubliq, 1-jullf—f-u-N for the holding of the hereinafter described event: <br />the <br />Event Name <br />11414P&H-cll <br />Street Closure <br />dame of <br />Street Street <br />114 A Al 70 V <br />From <br />To <br />Date, of Event <br />20 <br />Time <br />Setup <br />Ela.m. Wf7rn, <br />Start <br />i Time-E4 <br />Ela.m. P.m. <br />End <br />I Tunel <br />6 1 <br />❑a.m. <br />P.M.. <br />Approximate Number of <br />Attendees <br />Please answer the following appropriately: <br />• This event will be open to residents outside the immediate <br />neighborhood. <br />];p <br />�7—esE] <br />No <br />• All residents on the affected block have been notified and invited. A <br />copy of the flyer distributed is included. <br />1A, <br />-Tes <br />0 <br />No <br />• There is/are resident(s) affected by the event that may need ADA <br />transportation assistance to their residence. <br />El <br />Yes <br />P <br />'No <br />• This event will have music (live or other). <br />El I <br />Yes <br />No <br />Payment of $50,00 fee payable to City of South Bend included <br />Yes <br />Ej <br />No <br />Updated 08/2017 <br />