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• „ _„ P City of South Bend Special Event Application <br />Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Bring Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. Neighborhood Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accented. <br />Section A - Applicant Information �.,L' • �I 1 I <br />Date of Application: 8/ A / 2.o Z'S Organization Name: �Or T`A t>A- 1\'G&.4a6M C)4 <br />- a <br />Applicant (Contact) Name: <br />J f-{� �at I, ISti• <br />Applicant (Contact)Phone: It lt{-Zff� I O'OContact Email: co w� <br />� �{ <br />Address: 3..I5 VJalsl t -A _ City/State/ZIP: Spi .41 N1/ b 6 17 <br />Secondary Contact Names I_04E(la1r- <br />Contact Phone: 5'lti-.3n5-4o I'3 Contact Email: _r a}�1 m V1�t.) <br />Address: �Q I E .�� a City/State/ZIP: S$�/ l� I� 4 b 6/% <br />.,1 •' •rp. •.�. <br />Event Name : 24:6 m _ISAIM l h c Vl lc Expected Attendance: <br />Requested Street Closure: +61 WCLV4 S"f <br />From (Cross Street): .=4 L•& l�S �' <br />To (Cross Street): • �YiS '5+ • <br />Provide a brief description of the event: <br />AHhv4� $gC,TV 5C,koo( <br />resiQl'e ti%4 5 gxAL4, N•D <br />bui l re tc` ;ovtsk.(ps 1h <br />!PlGvt.IL TOY" Vle( �d• 600k <br />af{-aamkoo5 sLA=% -s,-k6 <br />-�h e co VM MQ u.l 443 • <br />Date of Event Setup [mm/dd/yyj: O 4� /� O Z 5 Time: q • 0 O cA V\'% <br />Begin Date of Event [mm/dd/yyl: OTr/ A 0 2 Time: S •.On b rv% <br />End Date of Event [mm/dd/yyl: 0 4 O Irr a 02r 3 Time: 8 • C5 e to j34 <br />Event Cleanup Completion [mm/dd/yyl: O q lO Sf dA3 Time: R . 14 vet — a O O M M <br />Have all residents on the affected block have been notified and invited? ❑ 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: e1 <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? ;yes ❑ No <br />