Special Event - Clover Street Block Party - July 8

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• • City of South Bend Special Event Application 2 Neighborhood Event $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. 1865 Please Brine Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd, South Bend, IN Review the Instructions on the Special Events page before completing the application. Neighborhood Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Section A - Applicant Information Date of Application: LlaG:a-� Organization Name:. Applicant (Contact) Name: W i Q iurv1 Las lee- c� Applicant (Contact) Phone: S14 4,Lt O O SS y Contact Email: PGr"*ec)-t2 W.ASu✓e 773( JJrna— • I • co Address: 11041 PJ60W Sk- City/State/ZIP: 'JOul� 6LYNA LI661.S Secondary Contact Name: 4 0An&- 4%- -L'W ContactPhone: Contact Email: ®*�ccuSi,r2 %!3�vma:/ca✓` Address: 1101 40- City/State/ZIP: Saw4'i, Ae"d L.V t/AAIS7- Event Name: 1., Ou e 5 BX6C - fQ-V � xpected Attendance: S 0 Requested Street Closure: Uwec �} From (Cross Street): pjable." To (Cross Street): H I I AfP Try Provide a brief description of the event: j}r22�- (,105LLVe ko Nav22 CLU uetc(Li ' }o yy� �w.q � vYni- a�cici- }v luy,cw Ct+c4` �r and allow }:.a �C icy 5 Vta.oa 4un anal Nda- uaov rY 0-107La daC�'c Date of Event Setup [mm/dd/yy): J LtU B c1M3 Time: 8 4M � Begin Date of Event [mm/dd/yy): ILA W ?i a3 Time: 9j a rv, End Date of Event [mm/dd/yy):��tA LV D ��!`� Time: % pr+ Event Cleanup Completion[mm/dd/yy]: jLl OAa3 Time: Om 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: Number of households represented by signatures on attached sheet: Will this event have music (live or other)? E3'Ves 0 No