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City of South Bend Special Event Application <br />Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Bring Comoleted 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 orthe application will not <br />be accepted. <br />Section A - Applicant Information <br />Date of Application: (o�lS Organization Name: <br />�-t�Q <br />Applicant (Contact) Name: � �'0 P1 A&0 fe / /< <br />Applicant (Contact)Phone: '31`� 33n tOCADContactEmail: MO4')0:TEe <br />Address: 131 �4 - 1157 City/State/ZIP: '5 ?'L <br />Secondary Contact Name <br />Contact Phone: <br />Email: <br />Address: City/State/ZIP: <br />/ Section B - Event Information <br />Event Name: J CJ �� L7 � e�-Za') Expected Attendance: <br />Requested Street Closure:// I <br />From (Cross Street): f-/ C l <br />To (Cross Street): IC wr__Cd <br />0 <br />Provide a brief description of the event: `fir} j �y �r<� j) ZZ: lDirJ/cZ r- C <br />w(,.•/-! = %�LSQI� <br />Date of Event Setup [mm/dd/yy]: ���/ems Time: <br />Begin Date of Event [mm/dd/yy]: ��r�a S Time: <br />End Date of Event [mm/dd/yy]: �`/`Time: <br />Event Cleanup Completion [mm/dd/yy]: % 15 442 Time: <br />Have all residents on the affected block have been notified and invited? <br />/!7 . 'c' oC4— r-r <br />/O 6" P <br />//. 'f� cn2 <br />•00 .4 n7 <br />❑' es ❑ No <br />• Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. <br />Numberof households fronting the proposed streetclosure: 1-6 <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? Yes ❑ No <br />