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City of South Bend Special Event Application <br />2 Neighborhood Event <br />• ` _! $25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />,ees <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 />�n <br />Sectioon /�n A - Applicant Information <br />Date of Application: l ycl - I IX* * Organization Name: <br />Applicant (Contact) <br />Applicant (Contact)Phone: G 6-<k(J lntactEmail: SG1A� f2l 1 s-A.70 <br />�d �/R�1�/r✓/�1 <br />Address:o� Wa(S � <br />City/State/ZIP: .)0(4 ' L)�/ :zlA(- wc(" <br />Secondary Contact Name:�^,I 1CZ^ I <br />Contact Phone: S7� , 2-S6SS-I - 7 Contact Email: <br />Address:n132a &clrn Sf City/State/ZIP: <br />• C(es;tA4 05 `S Section B - Event Information <br />Event Name: 4I`� S r r i� /[ Expected Attendance: I (9 tJ <br />Requested Street Closure: [� nn OWL &L <br />From (Cross Street): Ba S its r^ <br />To (Cross Street): - <br />Provide a brief description of the event: <br />1 nr✓(lc� a.. v`�2�-F--y n�j, �r�ac� o� P�t,`�'�-aX')v�,�• <br />Date of Event Setup [mm/dd/yy]: V7jaLc Time: 1 N ?- OG , 1I)^M <br />Begin Date of Event [mm/dd/yy]: r�7 /o��D ���5�—� Time: Woo � 4 <br />End Date of Event [mm/dd/yy]: 11 % �� �7 I ��T!me: -7'00 <br />Event Cleanup Completion[mm/dd/yy]: D7�a�0 %�J Time: ! o6 plu <br />Have all residents on the affected block have been notified and invited? P Yes ❑ No <br />Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. <br />• D Grow bot{ t— <br />Number of households fronting the proposed street closure: G4jo <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? [Yes 0 No <br />