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H City of South Bend Special Event Application <br />: Neighborhood Event <br />• W t P CC I <br />r $25 application fee if filed 30 days or greater (up to 180 days) in advance of event <br />Please Bring 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 />Date of Application: 5--I—VgaqOrganization Name <br />Applicant (Contact) Name: Clare tre- C. IUIJA� <br />Applicant (Contact)Phone: SAY-yoy-49e,-) Contact Email: /'�a�eacc�u.r�.�S3�9WV41t,ee0.� <br />Address: /00(a 5, 3f �= .5••FCML City/State/ZIP: SMAk ge i f) cIGG_� <br />Secondary Contact Name: <br />Contact Phone: PC(aP-39-7 (# Contact Email: Dunn Ko b ie r tot L7 QQ l M <br />Address: �OD�S 3%oJ��C! City/State/ZIP:c-�vTrl oQEn1bz� 11&G/S <br />• Section B - Event Information <br />Event Name : 1 rr E14W.6?0x jdj oa� F'Qe,"M i Expected Attendance: 4vCD <br />Requested Street Closures 31 5 t �� �E <br />From (Cross Street): <br />To (Cross Street): <br />Provide a brief description of the event: <br />%�Ql�� GAm�s� F��LGo u1Sf1�' <br />Date of Event Setup [mm/dd/yy]:0(�//%/2Time: <br />i <br />Begin Date of Event [mm/dd/yy]: Time: A� <br />End Date of Event [mm/dd/yy]: O6117/ 3 Time: <br />Event Cleanup Completion [mm/dd/yy]: (�4b 7/a- 3 Time: �• bo P%�1 <br />Have all residents on the affected block have been notified and invited? gYes ❑ 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 />