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oF�u�B 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 />1 66.1 <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 />Section A - Applicant Information <br />Date of Application: Ype1 2S Organization Name: ,�oseoh �rarle Sckool <br />Applicant(Contact)Name: 11&AtA0_k 17V2q <br />Applicant(Contact)Phone: (S';>(1)220'Z32s"Contact Email: hoyiA ,kiA1 3ok jmn%(.Cbryx <br />Address: 2I16 �4 +flu 5+ City/State/ZIP: .SDuff- Bond =^) Y66i7 <br />Secondary Contact Name: _NOf o lit 5 i oW.' <br />Contact Phone: (S74i 386' 38'NO Contact Email: tuS yrG(-i P VGhoo. coryl <br />Address: 2i6 N iI111 54. City/State/ZIP: 5,- L 11• , T�N W6 17 <br />40 Section B - Event Information <br />Event Name: Si. S6`Ds�pk cu- kml'If4d J;u Expected Attendance: 4/00-4SD <br />Requested Street Closure: 5. L65 Obik <br />From (Cross Street): ti • W+&� Aj-c • <br />To (Cross Street): F. Id3ikk A/"E <br />Provide a brief description of the event: <br />Ouc o-✓•n'jal fitk& DqY well %nck\A9 6j4ocK- 364Vres, Gch\A+M' , &Aa <br />lwu►L fw- ov( 'eA-h(-c skvd-Ln+- body. <br />Date of Event Setup [mm/dd/yy]: 6/ 6 /Z S Time: p7a 1 � <br />Begin Date of Event [mm/dd/yy]: 416 /Z S Time: D ► n. <br />End Date of Event [mm/dd/yy]: 6 I6 /25- Time: 3 P + <br />Event Cleanup Completion [mm/dd/yy]: 6 / 612 Time: K (1 A J L <br />(1b�'��1wt•C� ll`^" b <br />Have all residents on the affected block have been 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 f ronting the proposed street closure: d.pu,tL hv��g io ornflrC) <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? ❑ Yes ❑ No <br />