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• <br />,,, City of South Bend Special Event Application <br />G <br />d Neighborhood Event <br />_ rue J <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />\lBtiS <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 evert date or the application will not <br />oe acceprep. <br />Date of Application: ✓ / <br />GnnlirantWnntartl Namp- <br />Applicant (Contact) Phone:, <br />Address: /. ~f J' <br />Secondary Contact Name: <br />Contact Phone: n <br />Address:''' <br />• Event Name: <br />Requested Street Closure <br />Section A - Applicant Information <br />Organization Name: <br />�fii NLrclprf�� <br />From (Cross Street): V JV Y <br />To (Cross Street): / / <br />Provide a brief description of the a nt: <br />& Wh &V (. - <br />Email: <br />/ZIP: <br />AV 7,°31 U <br />Date of Event Setup [mm/dd/yy]: --77 0 / Time: //y OC dvYl <br />Begin Date of Event [mm/dd/yy]: o a3�ada3 Time: DHl <br />End Date of Event [mm✓ddA y]: / Time: /0 Pam' <br />i 1 n <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 resident in addition to signature attachment <br />• <br />Number of households fronting the proposed street closure: �t <br />Number of households represented by signatures on attached sheet: /U <br />Will this event have music (live or other)? M Yes ❑ No <br />