Special Event - South St. Block Party - July 17

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City of South Bend Special Event Application Neighborhood Event ;. $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: (D "`i� "a -_ Organization Name: �S_00 i'vl S_,, �O/t Applicant (ContacU Nae: �i1Pi Ili ' � mYt'1 Applicant (Contact) Phone: C %H 310 YM Contact —ct E—mail: —JYL In—tiM ILO r�— —C(J1"1--- C'64'1 Address: lel/^ C �otrF� Si- City/State/ZIP: sct.A-- Secondary Contact Name: Q '�Iau� I� -- Contact Phone: ��-7Lr - gamContact Email: �4 < , Address: y e &, xc. Sk _ City/State/ZIP: Sc.,At- 3z. d int Ykoco (ZI Section B - Event Information Event Name: tiSt 'lock Por Tc/ Expected Attendance: Requested Street Closure: �• SOdn� 1 S% - _—__---_-- From (Cross Street):/ �S • nY/l'syi e _------ To (Cross Street): _Z -0oo //ow Provide — Provide a brief description of the event: dock p;# rt wA gatpLeS � potluck Date of Event Setup (mm/dd/yy): 7 7 a� Time: 0 O _ Begin Date of Event (mm/dd/yy): _ i f % a Time: -- End Date of Event (mm/dd/yy): O'% / % _— Time: rJ 00 -- Event Cleanup Completion (mm/dd/yy):I 7 a _ Time: /0 ' 00 Have all residents on the affected block have been notified and invited? ry 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: = / --- Number of households represented by signatures on attached sheet:___ --- Will this event have music (live or other)? ❑ Yes allo