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n <br />U <br />C <br />41 <br />City of South Bend Special Event Application <br />e' 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:T '�C--)S Organization Name: <br />Applicant (Contact) Name: MI C Itae L. 1 �Ne Sg <br />Applicant (Contact)Phone: L5)'A)bIS--7_Ln Contact Email: 0,k210y21257Qania-,I.Cdwt. <br />Address: '�aS 5 Kali c1f N City/State/ZIP: V-DenO 3\+ cif HCC� <br />Secondary Contact Name:I ffs : <br />Contact Phone: (rD�y) 11S9 Contact Email: 10.Svyw',)a i �we � A rµc l CUcm <br />Address: ul City/State/ZIP: Sc..-1 \ V� P�'J. _'N y (X �( I <br />y� Section B - Event Information <br />Event Name : \"V"'\y ` 1 ` o� Tf du_ - CurExpected Attendance: 5C necz`1 E_ <br />Requested Street <br />From (Cross Street): gc'y"e_ V <br />as S. <br />To (Cross Street): SC < ^ e\ 2 <br />Provide a brief description of the event: 'vS c, �Grr ,\�I �{\�^ O��� '�O <br />("Ur Coal S _tM C.ren}Q, q ya(e I , C.\, arcl fneIAorci6le. Ceke6'-lion fork�\C <br />kx.`e) l hav2 � ar\cl ck v&'vi t•1,,t o F aacU"eS <br />QS well ag c rkS 0.4^d Cvq{� In" o \\ 4� S }n cv\�'ogS. <br />Date of Event Setup[mm/dd/yy]: LOUa035 Time: IO 00cm <br />11 <br />Begin Date of Event[mm/dd/yy]: �U\ysy+\ ���5 Time: •uogr1 <br />End Date of Event [mm/dd/yy]: �1\1kS y�h 35 Time: 1 C5 Ph1 <br />Event Cleanup Completion [mm/dd/yy]: ^ Time: 00) ci v � <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 />Will this event have music (live or other)? LJ Yes ❑ No <br />