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11 <br />City of South Bend Special Event Application <br />(g:� <br />) Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />y, <br />Please Brine 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 />Date of Application: oL1,9q!-906olS Organization Name: <br />- <br />Applicant(Contact)Name: /rI[►rCQ J Vin:f2on <br />Applicant (Contact) Phone: Contact Email: }T n 9%a 3 larrY_c.l I com _ <br />Address:a 3 (,) ,fMar- -Sd. City/State/ZIP: —'5cwh &04 Z.(7 <br />Secondary Contact Name: RI r i C e LL 411*M'-L <br />Contact Phone: S )q :36 % -0330 Contact Email: <br />Address:g99 i &rJ 'DI . City/State/ZIP: SOi,(+'h beAd, I A? HiCL-PT <br />�f <br />Section B - Event Information <br />Event Name: aW A (/; E ion Expected Attendance: 5o t <br />Requested Street Closure: I1Xtjk' pQr <br />From (Cross Street): 1E 19$19 <br />To (Cross Street): it- oS C P 1 <br />Provide a brief description of the event: m� SST 'jai or' C. r&& M is fN -for} -J <br />Date of Event Setup [mm/dd/yy]: Olo- 01- 90 95 Time: -I • U0 0.n^ <br />Begin Date of Event [mm/dd/yy]: 6 6 - o7 - n906 Time: �) -Oock m <br />End Date of Event[mm/dd/yy]: Qb- 07 9lOR5 Time Q. •rn <br />Event Cleanup Completion [mm/dd/yy]: a b -67 ' 0 S Time: <br />Have all residents on the affected block have been notified and invited? 0 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: <br />Number of households represented by signatures on attached sheet: J <br />Will this event have music (live or other)? 2 Yes ❑ No <br />