Special Event - Madison Street 4th. of July Party-July 4

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City of South Bend Special Event Application JUN 0 8 2021 Neighborhood Event 1s�_ rua 12 $25 application fee if filed 45 days or greater (up to 180 days) in advance of event $50 expedited application fee if filed 14-44 days in advance of event Review the Instructions on the Special Events page before completing the application. Neighborhood Special Event applications must be submitted more than 14 days in advance of the event date or the application will not be accepted. Section A - Applicant Information Date of Application:_`'____________ Organization Name: _____________________________________ Applicant (Contact) Name _JOS, b L` R >dr; _ems___ ______________ Applicant (Contact) Phone: _ S2'oZ (�SO_ContactEmail:_(tOLt_�_ Address: _I-a?.j—P MO :C.o r, _ City/State/ZIP: -Soc,L i 7 Secondary Contact Name: _1/�;ci,��t' _______________ Contact Phone: 3 _Contact Email: Address: _City/State/ZIP: ___------- _---- Section B - Event Information Event Name: /MadiSo(�.�, AA _ �� Oir ,S_LIJ ?QL*pected Attenclance: -3Q GL&� l�a/djI I n Requested Street ClosFe�L DJ&S Q� 7 -- — ---- — From (Cross Street):_d'PPin 1Q�wt_______ To (Cross Street): Provide a brief description of the event: Smoa\ b�OCk eo ray/ p�}\v c +-0 ceAtbra•Ap- s„�y y4,4�" Date of Event Setup [mm/dd/yy]: D-:7 —/Q� j�_ _ Time: 11 Q Q Q_� Y"1 Begin Date of Event [mm/dd/yy]: Q�f __Time: End Date of Event [mm/dd/yy]: Q-71 C)q-4 2-L_____ Time:__12D�-pN1------------ _—_— Event Cleanup Completion [mm/dd/yy]: L71Og1 zl__ Time: LA Have all residents on the affected block have been notified and invited? ❑ Yes ❑ No Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. Number of households fronting the proposed street closure: __L7-____ Number of households represented by signatures on attached sheet: Will this event have music (live or other)? ❑ Yes X No