Special Event - Fun in the Park - June 10

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CJ r 1 U C � J City of South Bend Special Event Application a Neighborhood Event 5, vua 1� $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. 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 G Date of Application: 6 L? r 23 Organization Name: ,uluut lCi TerroZe rk"'V& s AXGC I o, Applicant (Contact) Name: , )b N �j FA 0 uL-?� U A; 5(/-' Applicant (Contact) Phone: 51 `f " Contact Email: toe. -+Aei5Mbo" tiv�d� v�k; "lei t erv"e Address: E I P✓r ifd Al '0J City/State/ZIP: 5 f ` `t66 Secondary Contact Name: Contact Phone: Email: Address: City/State/ZIP: Section B - Event Information Event Name : •• � ' " vn n&' �CA Expected Attendance: b O r O U Requested Street Closu From (Cross Street): o 4 To (Cross Street): Provide a brief description of the event: a Je- �tu✓r ny a. W[a99c skew, f reaKS sf� we w Il pw..4 t)wp ff-) 1100 ME (L 170 r+140 le s( Date of Event Setup [mm/dd/yyl: / Time: Begin Date of Event [mm/dd/yyl: 0 6 10/2- 3 Time: End Date of Event [mm/dd/yy): 0 10 / 2 Time: Event Cleanup Completion [mm/dd/yy): O b 1 fO 1-3 T"11 w t 1 1 Have all residents on the affected block have been notified and invited? []Yes ❑ No a.4-G&-` on f y 1-3 hoof ey 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 orl theT. C] Yes 0 No 2-