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= 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 Conwil ted A_ugAir_ation and Payowart to: <br />Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN <br />Reviews the Instructions on the Special Events page beor, compl tine t aPplicati �:eig—^-fx�od Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be acce ed <br />1 Section �A - Applicant Information <br />Date of Application: Mt �of +� d� 1:rgani�^tiar Name: <br />Applicant (Contact) Name: W i 11 t aL^ l LOL%Y-� <br />Apr i am i� :t, Ph; ?cl-4�lo-l7Sr�`� c� '.X. €--:r. Po r-Fe- r!' n 1Sur�77S®per <br />Address: P G61 Gcxt-ey- S'I- City/State/ZIP:' S0L4-)--h PIMnOt 4661s <br />Secondary Contact Nam*: J dC-An n a r <br />Contact Phone: &Lf'7-4a7 -6(401 Contact Email. Pe-Y c�rn�.nn gr ✓��7i� �te'tctr% a°r'' <br />Andrea: l l oq el d u-e ✓ s 4- CityGtat@aM 5041kk 6k�d �fGtc/ <br />• Section B - Event Information <br />Event Na ic: L( 1U2t! �� SIGC.k /��. ExpacaadPftx4dI2ftM <br />50 <br />Requested Street Closure: e Oy' ' ,)- <br />From (Cross <br />To (Cross Str <br />Provide a brief description of the event: <br />�--U kruotA.) each. O�Kti- Oinct 041Ow Y--ids -�-u i'1ct <br />art tY� LL:) AV, jL — *4-4, WC>V-rl 04' VQJI\iGU-S <br />Date of Event Setup [mm/dd/Yyl:JL41kl I-X ao'a S- Time: R rv\. <br />Begin, Date of€ver;tImn%/deSM'k it`t�V�.aoasTma o'er` <br />End Date of Event imm/dd/yyl: u 13- a 02L 5� Time: <br />Event Cleanup Completion (tr9n/dd/yy7: ,A5kl�_I a .2 O� $� 7huue: �py-%.- <br />Have all residents on the affected block have been notified and invited? 'Q11es ❑ No <br />Pleas€ attach a copy of the d=r ho.:ber 0r � f u-wd t0 nts .n W it— to s:61, a! u. e - acNnent <br />Number of households fronting the proposed street closure: aDl <br />Number of households repre<--nted by signatu:r-., on —�tachtd sheet - i I <br />WIN this event have n-sic Vive, or other;? 0 Yes a'40 <br />