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eP City of South Bend Special Event Application <br />w1dII Neighborhood Event <br />• \r" _= 7 $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: S/01-/ ! yyo'? Organization Name: <br />Applicant(Contact)Name: //C� -Y/ ©lee <br />Applicant (Contact) Phone: 7 <br />Email: <br />Address: City/State/ZIP: <br />Secondary Con qt ame: <br />Contact Phone: <br />Address: <br />• Event Name: IV <br />Requested Street Closure <br />From (Cross Street):_ <br />To (Cross Street): <br />City/State/ZIP: <br />Provide a brief description 9f the event: / <br />Date of Event Setup [mm/dd/yy]: -7 C?! Time: /7l <br />Begin Date of Event [mm/dd/yyl:-7 /-3 r�� Time: <br />End Date of Event [mm/dd/yy]: 02 Time: 12�) <br />Event Cleanup Completion [mm/dd/yy]: Time: �4:2� 4rt✓►' <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 fronting the proposed street closure: 1p <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? L9esYes 0 No <br />