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• <br />xn 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 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 />/ I Section A - Applicant Information <br />Date of Application: `1 �a -� Organization Name: aet a <br />Applicant (Contact) Name: at( tttJJJ <br />Applicant (Contact) Phone: �- 334 �;`i Contact Email: <br />Address: [Z`,/)��'� iQ- S�' City/State/ZIP: <br />Secondary Contact <br />��''fName: T3 r`3 I 2(jdCC// � <br />Contact Phone: 5-'t"- 3 3q- 7 `I Contact Email: I'd pr%✓� � (� kid • eA ` <br />Address: SAM-e- City/State/ZIP: 50xM-e- <br />• Event Name: <br />Requested Street <br />From (Cross Stree <br />petted Attendance:a 0^ / 00 <br />e /er 4 Foslk- Sf e <br />OrM'o, <br />To (Cross Street): r >r <br />�/S �L1CL S l ��L,%✓a cn. J rs <br />Provide a brief description of the event: LC (r Q ✓ 6 <br />l/tf� lJQ U, !I hrst t+ 1 h--er-< A t wz (✓ � GCCSG G� <br />jA<&-S as ow e r, vim, G � d r� %w of qLr <br />A I, s- Lev 71 Get. 5/vu s �r�, ���► -�o sef <br />Date of Event Setup [mm/dd/yy]: c�Tlt nc lam U24 Time: or 9YY1 <br />Begin Date of Event[mm/dd/yy]: vim 1.2,01.4 Time:11 <br />( ✓►t <br />End Date of Event [mm/dd/yy]: iC '-z-A. J.07114 Time: <br />J ` jam <br />Event Cleanup Completion [mm/dd/yy]: /. �`Time: / L <br />Have all residents on the affected block have been notified and invited? O '4 es ❑ 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 d- <br />Number of households represented by signatures on attached sheet: <br />ju 54- ryiu-s, e- -A( ,SL 0,'v <br />Will this event have music (live or other)? <br />hCNIN4 I5 <br />0 Yes ❑ No <br />