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• <br />0 <br />• <br />5t City of South Bend Special Event Application <br />h _ <br />\o. <br />Neighborhood Event <br />I( <br />._I $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 - Applicant Information <br />f <br />Date of Application: nr) N3Organization Name: <br />Applicant (Contact) Name:r^�. C A r <br />Applicant (Contact)�Phone;54c -221- /Offs Contact Email: d IOck k-1 Rr k to S m 4MR. L- Cam <br />Address: /�7 (; • f f 2-e--, Z iP City/State/ZIP/: 52� 6C�Q' ye'.) V6��? <br />Secondary <br />Contact <br />Email: <br />Address: W2- -C-. "R)?a AVe- City/State/ZIP: b6-iAh &2L ��_T y6�l3 <br />i <br />Event Name : _1171 r' <br />Requested Street <br />Attendance: R(p <br />From (Cross Street):_ I n4-js sr+7p (:-ArV 1 3-- <br />To(Cross Street): -V-3 c*,c-re J1 S'%— <br />Provide a brief description of the event: <br />Date of Event Setup [mm/dd/yy]: ��� �- ��Time: "Op YY1 <br />Begin Date of Event [mm/dd/yy]:j 2-0 —_Time: Ckf� M <br />End Date of Event [mm/dd/yyTime: I Q: t9of ! <br />Event Cleanup Completion [mm/dd/yy]:aTime: ►Yl <br />Have all residents on the affected block have been notified and invited? 0-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:21 <br />y <br />Will this event have music (live or the ? 2 Yes ❑ No <br />