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• -;, City of South Bend Special Event Application <br />Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />w 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 event date or the application will not <br />be accepted. <br />Section A - Applicant Information <br />Date of Application: Q1IT2.01-2L_Organization Name: <br />Applicant (Contact) Name: LAA1 Z>UJ tt <br />Applicant (Contact) Phone: C5'1y) 58N- Aontact Email: dQt_ sV�C�'rnakl-Cn n x <br />Address: c{29 I; UGL! J+-5h S`j"' City/State/ZIP: Ct U PY" IN LI.0 13 <br />Secondary Contact Name: <br />Contact Phone: Contact Email: <br />Address: <br />on B - Event Informat <br />Event Name: A/\ik, liS {5�� �yr4 1 d aExpected Attendance: -in <br />Requested Street Closure: t J:cc <br />From (Cross Street): Lsi,T..O" S� <br />To (Cross Street): M� I t U h S-' <br />Provide a brief description of the event: <br />Date of Event Setup(mm/dd/yyl: 09_1 ZJime: OaVV-\ <br />Begin Date of Event [mm/dd/yyl: 6� I �—( II i Time: <br />'-1 orv1 <br />End Date of Event;mm/dd/yyl: Time: <br />pYV1 <br />Event Cleanup Completion [mm/dd/yy]: s <br />121 <br />12 � Time: <br />.D YV1 <br />Have all residents on the affected block have been notified and invited? Lyres ❑ 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: <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? yes ❑ No <br />