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• <br />0 <br />C� <br />City of South Bend Special Event Application <br />4 <br />o' 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, I N <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 accented. <br />Section A - AoMicant Information <br />Date of Application: ,! 14np t r Organization Name: e 7 <br />Applicant (Contact) Name: 1'%/ - [...s W1 L/ i <br />Applicant (Contact) Phone: 40-A I& Contact Email: M,r e/ fd . e�. �oL . Lor►� <br />Address: P.O. fi s4 i City/State/ZIP: S osa. tG /3 CA-O "4 <br />Secondary Contact Name: <br />Contact Phone: Contact Email: <br />Address: City/State/ZIP: <br />Section B - Event Information <br />Event Name: 11 wck Zo se'loox 'C `4 q Expected Attendance: <br />Requested Street <br />From (Cross Street): e e l/ e k e <br />To (Cross Street): <br />r <br />ee <br />Provide a brief description of the event: p o o k / Ge <br />el <br />(" / /tee (tea- W 4 j <br />Date of Event Setup [mm/dd/yy]: Ra. y t,- S f !2 7/i Time: °l oo rd /I/ <br />Begin Date of Event [mm/dd/yy]: IB"• dY i o h Time: t O: w j#A <br />End Date of Event [mm/dd/yy]: J3a,. t e r 7 144 Time: Co ire <br />Event Cleanup Completion [mm/dd/yy]: Mom. rw r / h to Time: if s'> Aar <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: IV O M C <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? "es (-No <br />