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0 <br />City of South Bend Special Event Application <br />ML <br />Neighborhood Event <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 />JJ / Section A - Applicant Information ' f <br />Date of Application: Io�GG'/i!/23 Organization Name: F0�'•Sr"�`� 1".44 6�Yq <br />Applicant (Contact) <br />q <br />Applicant (Contact) Phone: S—qq-339- 14-N Contact Email: <br />It <br />it <br />F/ <br />Address: q2'0 • t� / City/State/ZIP: 5OuA E-d, �l�i vY1o&1 <br />Secondary Contact Name: -rem C7 t r „4�1 <br />Contact Phone: Contact Email: i �Li/ rrl /ter <br />Address: 115' N3-� D-2vr-r L City/State/ZIP: Li(�G <br />Event Name: AWOboy 11 l 2allyrn-b%e <br />Requested Street <br />From (Cross StreE <br />To (Cross Street): <br />Provide a brief description of the event: <br />U_.. r ursl- <br />A <br />5-F. C 1(05`of xv�" <br />5lw.,e 4AA a.11e) <br />alle 4,Atf ru#is <br />a ner <br />-(P.- 3a..aSX <br />!oa✓ '• b 1 ocic PA ae6e ss l <br />lh <br />ea r l-/t✓e s� <br />" i h -� 'Zt le� <br />as�ee#7q f -lam <br />%D - 11-0 <br />S* 6 <br />,#l! ilersh6015 <br />fDate�ef Event Setup [mm/dd/yy]:Am, 11 2 D2 ✓ Time: � m <br />Begin Date of Event [mm/dd/yy]: Xe. / Z0 2-3 Time: <br />End Date of Event [mm/dd/yy]: /� 2-V 2-3 Time: 0 ", <br />Event Cleanup Completion[mm/dd/yy]: 202,Time: Om <br />Have all residents on the affected block have been notified and invited? PIes ❑ No <br />Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. <br />• all�ryy , 1 <br />Number of households fronting the proposed stfeet closure: <br />Number of households represented by signatures on ttached sheet: <br />Will this event have music (live or other)? Eryes ❑ No <br />