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` f4icTg,_R;,, 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 />�s <br />Please Bring Completed Apolication 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: c, 127 /0-V Organization Name: <br />Applicant(Contact)Name: `A ) Ur CIM <br />Applicant (Contact)Phone:.57/'4/4U 0554 Contact Email: /zJ �c�rn�a5cc✓e773�9/114�Corrr <br />Address: 110c1 Oyue-r City/State/ZIP: Soy. In ge-A-L/PJ Ybcy� <br />Secondary Contact Name: _ _ /a ran q Lw 4 PY - LcpSke <br />Contact Phone: �Y7 1 &7 br(O% ContactEmail: 1'erFe_rJ tectgr�i p 7)g Q9Ena./coi,. <br />Address: //U `% (7 by i1-e✓ S City/State/ZIP: <br />f <br />Event Name: V 0 a z,r S } N- 6C /L I" Expected Attendance: 50 <br />Requested Street Closure: C%OUev 5� <br />From (Cross Street): <br />To (Cross Street): <br />Provide a brief description of the event: <br />6}me4 e_bo5u_� -4' k_-v.,e kl cth�ooe-5 fc) <br />cie_i- �-o L_nc�w eack c4ka-r c onak_ 6A0\,' t4^2 <br />IcM:5 �-o kov-e_ Fw, L.\ji4kc)Lx+- a-h¢ wovvy OP ve4Nict-'P_S <br />Date of Event Setup(mm/dd/yyj: cJLAfA _ 99 aoay Time: 8 4"-1 <br />Begin Date of Event [mm/dd/yyj: JL4447 -2 9 4c&2 t/ Time: 9 'tm <br />End Date of Event [mm/dd/yyj: 2U c/ Time: -7 gr'+7 <br />Event Cleanup Completion[mm/dd/yyj: Jctu -907YTime: 00f 7 <br />Have all residents on the affected block have been notified and invited? ❑ 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: 12 a �n/ g <br />Number of households represented by signatures on attached sheet: / of &5ji 'S oj <br />,a rx»d <br />Will this event have music (live or other)? ❑ Yes / <br />