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LJ <br />• <br />i <br />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 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: , Organization Name: <br />Applicant (Contact) Name: <br />La ire. S �OhnSovti <br />f q �7Le-! 'Lt ms resho► <br />o Applicant (Contact) Ph" eontact Email: <br />Address: <br />Secondary Contact Name.j VAU/ t 0 <br />OL <br />4U(M <br />Contact Phone- r''QrIli 69—I r I 5 1` 5 Contact Email: ` j� ] p I <br />Address: J0. J J '1 n1�1y City/State/ZIP: Q�� I " `-r ` <br />Event Name: % \� <br />Requested Street <br />From (Cross Stret <br />To (Cross Street): <br />Attendance:Expected 50 <br />PBkvv <br />a brief des ription of the event: <br />V+tgdacj U b nk-4 m Mir, <br />1,1�4ihI? I. <br />Date of Event Setup [mm/dd/yy]: �� <br />Begin Date of Event [mm/dd/yy]: <br />End Date of Event [mm/dd/yy]: <br />Event Cleanup Completion [mm/dd/yy]: <br />t <br />Have all residents on the affected block have been <br />A 5 Time: a n V <br />XXTime: <br />C((ff II�n�,, ime: �Nj <br />�ffine: ' O' <br />fied and invited? es <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: <br />Will this event have music (live or other)? Yes ❑ No <br />