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r 11 <br />L <br />• <br />City of South Bend Special Event Application <br />Neighborhood Event <br />Ipj <br />I'S�\. PEacc7+ <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Brine Completed AoDlication 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 />Date of Application: <br />Applicant (Contact) <br />Section A - Applicant Information <br />Organization Name: -rj4`E-_E a/iTEQ OG AnIJ Ld-, <br />Applicant (Contact) Phone: w oZ71-%C 3 � Contact Email: (�h it -A �Q?53 90 1GM�l/li/l.,(VA <br />Address: 3,2I v• /' CNUSM City/State/ZIP: DOl4fF{ b6'UD'SV. I601 <br />Secondary Contact Name: <br />Contact Phone: <br />Address: <br />Email: <br />�% I I Section B - Event Information <br />Event Name: I �Of Expected Attendance: Uw)e'7r X-Afs'tJE9 <br />I� <br />Requested Street Closure: v' 1 p t4EP-50%J <br />From (Cross <br />To (Cross Str <br />Provide a brief description of the event: <br />Date of Event Setup [mm/dd/yy <br />Begin Date of Event [mm/dd/yy <br />End Date of Event [mm/dd/yy]: <br />Event Cleanup Completion [mn <br />Time: Aof <br />Time: � / P/Vt <br />_Time: _7P/"t/ <br />Time: 'Awl <br />Have all residents on the affected block have been notified and invited? JX 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: I <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? ❑ Yes A No <br />