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00 1 <br />rs. City of South Bend Special Event Application <br />�® c Neighborhood Event <br />ram+; <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 �n��7� <br />Date of Application: 2- Or j� <br />anization Name: )'� CIUy'[ S II`yzlc- <br />Applicant (Contact) Name: l 10 S �l L <br />Applicant (Contact) Phone:: -11 Y- r�s,[- / R -& !&ntact Email: ' I <br />Address: 7 L I`TVyL`�'1 G �`C'ity/S°ta�te/ZIP: 5 CUB 3 `"I Quo <br />V m �Z rL lit fh l�1 C_ <br />Secondary Contact Nam�e,:/y�2 `, <br />ContactPhonetl1�-3 ✓5S a Contact Email: Address: I�5City/State/ZIP: 9QC" �D u a [n (3 <br />.-.1 •i FM, a •ru,. •� <br />Event Name: J V IQ 9 • d- U oil Expected Attendance: <br />Requested Street Closure: I tY�i H a4et-I W e- <br />From (Cross Street): +-:e11 0 LV 7 . 7 t- <br />/1 <br />To (Cross Street): J rj CJ `N� Ci S <br />Provide a brief description of the event: <br />c <br />Date of Event Setup [mm/dd/yy]-.-S_T •• a Time: C2 t to <br />Begin Date of Event [mm/dd/W]: , U Y L4, Time: <br />End Date of Event [mm/dd/yy]: _ i U (4 L1, <br />ta � 5 Time: <br />Event Cleanup Completion [mm/dd/yy]: j u (�9 i �� Time: <br />Have all residents on the affected block have been notified and invited? -Wes ❑ 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: r1 <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? es ❑ No <br />