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U <br />• <br />• <br />Te City of South Bend Special Event Application <br />c <br />Neighborhood Event <br />"!t`> $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />moans <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 accepted. <br />Section A - Applicant Information <br />Date of Application: 0 d/.;2 0,;2 --/ Organization Name: ✓ ���� <br />Applicant (Contact) <br />Applicant (Contact) Phone: <br />Address: <br />Email: 0 ) D t) <br />ZIP:, <br />Secondary Contact Name: , I /p/41!�T/ ///t 1 /t' <br />Contact Phone:�%�C'%a''ir,A/73��/// Contact Email: /4q1L: GN'4 3lmw <br />Address: !� J Clljw9WI, —City/State/ZIP: C�56 47 id <br />Event Name: _4Q <br />Requested Street <br />From (Cross Stret <br />To (Cross Street): <br />Provide a brief description of the ev <br />1-1 <br />Date of Event Setup [mm/dd/yy]: / / C/ <br />Begin Date of Event [mm/dd/yy1: 0 <br />End Date of Event [mm/dd/yy]: <br />Event Cleanup Completion [mm/dd/yy]:� <br />Have all residents on the affected block have <br />Attendance: /00 <br />V <br />60Al -6—,/n <br />Time: 0/71 <br />144 Time: <br />� Time: <br />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: 1 <br />Number of households represented by signatur s on attached sheet: <br />Will this event have music (live or other)? Yes ❑ No <br />