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• <br />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 />awP <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 />Date of Application: 5-5-2- <br />Applicant (Contact) <br />Section A - Applicant Information <br />JC►11 Ca Co <br />Applicant (Contact) Phone:51q' $55.3(o <br />Organization Name: <br />Contact Email: GhIG� hamaclw,_►' �1o�lmaI/.(OKI <br />Address: 10'J N. LSKOrIMS104 AYC City/State/ZIP: t OR011Lhd W 4"vj 3 <br />Secondary Contact Name: a. ame: KVA- ka-rLt <br />�1 <br />Contact Phone: 51 1 -z3If - 3519 Contact Email: OL Vk. K"Lto ot <br />Addressjl 3 t • WaS✓11hG1fWl St'City/State/ZIP: S0V- - pat ' <br />hol N -IieW l <br />• Event Name :t. Waskim <br />Requested Street Closure: f- <br />From (Cross Street): k� r�1k, <br />To (Cross Street): �� <br />Section B - Event Information <br />Sly I ri <br />Provide a brief description of the event: <br />NtIjkbo1-hood 510ck part-, <br />Attendance: 100 <br />Date of Event Setup [mm/dd/yy]: 0=-77 <br />-/ Z b12 5 Time: I I a -ha <br />Begin Date of Event [mm/dd/yy2-5 Time: 2- <br />End Date of Event [mm/dd/yy]:5 Time: 6 nr, <br />EventCleanup Completion [mm/dd/yy]:0-7 /21P 175 Time: 6 M <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: 10 Q r <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live crother)? 0 Yes No <br />