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��Tiila- City of South Bend Special Event Application <br />`I Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Brine Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. Neighborhood Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accented. <br />Section A - Applicant Information / 4,/Date of Application: �Z'�y ZOLZ Organization Name: /lldN 4 WmO elf M 7k-e CootYWA/ <br />Applicant (Contact) Name: <br />Hwy schobq YftuK�`ny 4 d/./kxlnce <br />Applicant (Contact)) Phone.-339- ZQ I S Contact Email: <br />huff <br />V <br />&ail, Coro <br />Address: 3gi5 K.l�l(Sidt t. City/State/ZIP: <br />�-"s <br />ot)y %A <br />&4,_TN <br />q&&zS <br />Secondary Contact Name: X&OLY ��/c/VV/S r <br />Contact Phone: UtL 300 - 27 Contact Email: <br />Address: <br />Event Name: <br />Requested Street <br />City/State/ZIP: <br />Section B - Event Information <br />Attendance: -3 00 <br />u 14- -� mt-IL 3>c 6107 <br />From (Cross Street):.f/.dYI Sua <br />vCi4-M36IV9 I c-nT <br />I"' 4Lr'- <br />To (Cross Street): �i1-C((SUYt 1 InL/L 61d i cwk hf <br />Provide a brief description of the event: <br />MLIL fk. 6tftbKaJ1)oA /nt+'tL w� llf fbc y ukK S�. Tal~n SapJls� <br />(1404 it IJrt li T--eam. 2f74 Vea4 -&4 fkt aoihuul MLk ik, <br />Date of Event Setup [mm/dd/yy): 01116 l 20Z 3 Time: I I (A M <br />Begin Date of Event [mm/dd/yy): O I -1 (P / ZOZ3 Time: I I arl <br />End Date of Event [mm/dd/yy): O I J I6 '70a Time: I 0 rA <br />Event Cleanup Completion[mm/dd/yy): OI f fifI_ M-Time: DVYI <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. <br />Number of households fronting the proposed street closure: IV ft <br />Number of households represented by signatures on attac ed sheet: <br />Will this event have music (live or other)? ❑Yes No <br />