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4 TH i City of South Bend Special Event Application <br />Z' Neighborhood Event <br />IO1 log <br />• $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Brine Comoleted 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 accented. <br />Section A - Applicant Information <br />f <br />Date of Application: �Zh I a Organization Name: <br />Applicant (Contact) Name: l V.JI lJ.a/ C y <br />Applicant(CContact)Phone: 1 e`c( ontactEmail:dl <br />Address: I I 7A \P� ol��`)C 3�- City/State/ZIP: <br />r <br />Secondary Contact Name: <br />Contact Phone: <br />Email: <br />Address: City/State/ZIP: <br />• L Section B -- Event Information <br />Event Name: Glad 11(ol'd') a y 1 U Expected Attendance: _ UT(r <br />Requested Street Closure: tP— t er'S <br />From (Cross Stree <br />To (Cross Street): <br />Provide a brief description of the event: <br />C Vadwa�bon PORN C'THs) <br />W x\ \ Vos e- OkAl 1 C1'A ACkV-r n <br />Date of Event Setup [mm/dd/yy]: �D �-3 Time: E, Q I Y:) <br />Begin Date of Event [mm/dd/yy]: Lb ll ��' I Time: ka-QkY) <br />End Date of Event [mm/dd/yy]: \,-f) \ 11' 2.2, Time: Ci !pyy) <br />Event Cleanup Completion[mm/dd/yy]: Wn\ Time: ��9✓l) <br />Have all residents on the affected block have been notified and invited? O_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: ,`7I <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? ❑ Yes t�No <br />