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City of South Bend Special Event Application <br />Neighborhood Event <br />$25 application fee if filed 45 days or greater (up to 180 days) in advance of event <br />$50 expedited application fee if filed 14-44 days in advance of event <br />Review the Instructions on the Special Events page before completing the application. Neighborhood Special <br />Event applications must be submitted more than 14 days in advance of the event date or the application will not <br />be accepted. <br />Section A - Aoolicant Information <br />Date of Application: 101Z <br />-1 Organization Name: <br />Applicant (Contact) Name:— / ,, I — <br />Applicant (Contact) Phone: ;74 - / S �(A Contact Email: �] <br />Address: 1,311 S.Mi —City/State/ZIP: <br />Secondary Contact Name: �._ <br />f <br />Contact Phone: S Email: <br />Contact Emai <br />Address: 3 S- T6+ <br />/" City/State/ZIP: _ (z(A— <br />Section B - Event Information <br />Event Name: _&L Expected Attendance:—��---- <br />Requested Street Closure:__C�4sF' a <br />From (Cross Street):—L_)e� r"W__--- _-- <br />To (Cross Street): <br />Provide a brief description of the event: ` <br />i -L nk4-c- , .MQjt;5 Gres j4 L Mld¢ ic. Ave at( l <br />a <br />tawJ%ed5 W.1�...>;�n I${:e aJiauQst..2�y�0 <br />Date of Event Setup [mm/dd/yy]: __—.79" <br />1 'U —__ Time: __6 -^ 1 -- <br />Begin Date of Event (mm/dd/yy]:--- 9 (31 f 2[ Time: —_f 4 <br />End Date of Event [mm/dd/yy]:----- 7 131171 —Time: -- <br />Event Cleanup Completion [mm/dd/yy]: 2b//7-1 — Time: <br />Have all residents on the affected block have been notified and invited? ® Yes ❑ No <br />Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment I <br />Number of households fronting the proposed street closure: <br />Number of households represented by signatures on attached sheet: ua Ignc_ C-(Osj <br />Will this event have music (live or other)? WrYes ❑ No S"� + 5. lot- 4-e <br />Gfosei� o uj Z TA4V. <br />