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714 <br />R City of South Bend Special Event Application <br />1. Neighborhood Event <br />EkCE <br />"R :'` $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 accepted. <br />Section A - Aoolicant Information <br />t <br />Date of Application: 7 a`-1 Organization Name: <br />Applicant (Contact) <br />U <br />r <br />Applicant (Contact) P/hone:/57`/- S3ot"J q �(7 Contact Email: U O iP�h i'kl G/ SYO!? /� / Co/✓ b1119 }/'Ld� <br />21 <br />Address: �� 7 17 / //l'f F' `1 City/State/ZIP: S 9f4 4 z7C 1-hOT Uhli�� <br />Secondary Contact Name: _ <br />Contact Phone: <br />Address: <br />• Event Name: �cC3 i <br />Requested Street Closure: -/ <br />From (Cross <br />To (Cross Str <br />• <br />Contact Email: <br />A <br />_ems MF- r 4 515._u <br />Attendance: 'C <br />Provide a brief description of the event: �u S,f `a fl-I' / l <br />US -1r50� 7' el <br />�'�A cry P'*?MSi6 <br />Date of Event Setup [mm/dd/yyj: 0 7- 0'- A 3 Time: GD P/>7 <br />Begin Date of Event (mm/dd/yyj: G 7 ' 0 y - �, 3 Time: cc, //j <br />End Date of Event [mm/dd/yyj: Time: <br />Event Cleanup Completion [mm/dd/yyj: 0 r Y^A. 7 Time: ✓ 4 6v0 �9/y7 <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: <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? ® Yes ❑ No <br />