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City of South Bend Special Event Application <br />�d <br />o` Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />1&i5 <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 />/�,j Section A - Applicant Information <br />Date of Application: / V Organization Name: Nl� <br />Applicant (Contact) Name: /rZoc_ IjLtAe I <br />Applicant(Contact)Phone-5 /-. 71�n'VO Contact Email: (4 ,//_ Gl <br />Address:/ay� A)L^� _) City/State/ZIP: J!/1. CM &wj <br />Secondary Contact Name: <br />Contact Phone.,5-7-,�%%V Contact Email: <br />Address:10LI&V,-) �✓✓i�/,�:F City/State/ZIP:s <br />. -Evn I in <br />/' ! - 1G <br />Event Name: 'j �/— ! I�IxoectedAttendance: /Jf��� <br />Requested Street Closure: C�i�er 1 ��e. <br />From (Cross <br />To (Cross Street): <br />Provide abrie/f description of the event: `[ [ i l;1 �j� Gv <br />/J e y�] �v �tooj oCl /Jeq- �- /,� A gcCVpt/ QD <br />and / <br />/ Time: ? DU Aw <br />Time: D/'4 <br />Time: <br />Time: ��• <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: <br />Number of households represented by signatures on attached sheet: <br />0Will this event have music (live or other)? Yes ❑ No <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 />