Special Event - Community Block Party - August 5

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• u • City of South Bend Special Event Application d Neighborhood Event � $25 application fee if filed 30 days or greater (up to 180 days) in advance of event ,eus 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 - Aoolicant Information n Date of Application: 4I�g1,-AP3 Organization Name: ss,Ma',� Applicant (Contact) Applicant (Contact) Phone: 57481G-y1q1 Contact Email: m f-m he o Top S6Ce1 A to ba.) , n e4- Address: 14 a0 S - G i - - ILu,SK�4ity/State2lP: &u: x /h Secondary Contact Name: h ( 11'Ll ag Contact Phone: Sr7q ontact Email: CkLJ d Sr I Q )40 , C 0vh Address: 14-10 .% ';4 �aS4t_ City/State/ZIP: CZ>C� Ld 'n qtf 13 lZ-71: owmali. . Event Name: LAt+tm,,,. u Mock [ G.4i ExoectedAttendance: 3 D 0 Requested Street From (Cross Street): F e- 1100 WS To (Cross Street): —'A V o Sco 4 Provide a brief description of the event: C1 Nrnrrwju;L r(UL�I trLo CLL eviscn& -C,,m t4R boor (Od P' Date of Event Setup [mm/dd/yy]: C �a0 a3 Time: R Begin Date of Event [mm/dd/yy]: ►y1AA� Gi, tk0 d-3 Time: f l AM End Date of Event [mm/dd/yy]: G 0 X3 Time: 3 prrm Event Cleanup Completion[mm/dd/yy]: C 3 Time: Pry\ Have all residents on the affected block have b n no and invited? es ❑ No 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: I -:),- Number of households represented by signatures on attached sheet: Will this event have music (live or other)? [!s Yes ❑ No