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• x «ti aE y City of South Bend Special Event Application <br />J> 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 accepted. <br />'7 Section A- Applicant Information ^,, <br />Date of Application: I 17' 1�y Organization Name: fie Jc) r I <br />�'S / ' I • �C-ZT r/�_ <br />Applicant (Contact) Name:O r l � / ga/ I - c �q /— l <br />Applicant (Contact) Phone:'. 57c� �S�5 <br />v�v AW04L�'rt <br />Address: W <br />Contact Email: <br />y /State/ZIP: <br />T9-- <br />So f�%! <br />¢�1 r <br />//�J "i <br />Secondary Contact Name: <br />Contact Phone: `»»"�- <br />3oa -37 <br />ContactEmail: <br />Address: ��t7Z �- <br />4 Avie <br />City/State/ZIP: <br />�fJC3>LG� <br />Event Nam <br />Requested <br />From (Cron <br />To (Cross S <br />Provide a brief description of the event: <br />Date of Event Setup [mm/dd/yy]: ppU —1-7— c2L/_Time: ( Y� <br />Begin Date of Event [mm/dd/r/]: !; h Time: <br />End Date of Event [mm/dd/yyl: " — Time: I I r <br />q� <br />Event Cleanup Completion[mm/dd/yyl: I t3o Time:�� <br />Have all residents on the affected block have been notified and invited? 021es ❑ 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: 2 <br />Number of households represented by signatures attached sheet: <br />Will this event have music (live or other)? yes 0 No <br />