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T1 BF <br />04 �\ <br />I8fi5 <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 />Please Bring 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: �Z7-10 0 -Z- Organization Name: C01f-V'-X /IPC��bo(5 <br />Applicant (Contact) Name: Ltsd (1 ay' Oe� b <br />Applicant (Contact)Phone: (S7`i)ZZo'Z325-Contact Email: ��v�ncl�krlQ3CSnIa��'C6N1 <br />Address: ISZ7 E (y.`-Gtx kC. City/State/ZIP: Sc iit�(� L� '1/66(7 <br />Secondary Contact Name: <br />Contact Phone: (574) Z 9 Z - 271 Z Contact Email: <br />Address: I6I5- E Coi rglt. City/State/ZIP: s��t-r d 5--N A07 <br />• Section B - Event Information <br />Event Name: 0loC[C ea( v Expected Attendance: <br />Requested Street Closure: ( o I `< 4-t <br />From (Cross Street): TL�YCk F41 IhaM <br />To (Cross Street): <br />Provide af7brief description of the event: I i <br />�rAnn�G� I--o-'1l�hefllc^e� IC�toc1C a� 6� j( ZP� ✓may us5 Po+ l <br />9 C •�\ +� J \C�-L ns 6C-k"".AYS- . . <br />Date of Event Setup [mm/dd/yyl: q/Z 7 /Z uZ S Time: 2.00 <br />n <br />Begin Date of Event [mm/dd/yyl: q 12 712 c Z S Time: o 0 0 r <br />End Date of Event[mm/dd/yyl: g1Z7/2o75- Time: 7 0i� <br />Event Cleanup Completion [mm/dd/yyl: 9 / Z 71 Zoe i Time:yU n r"- <br />Have all residents on the affected block have been notified and invited? [g'�es ❑ 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: 13 <br />Number of households represented by signatures op attached sheet: 13 <br />Will this event have music (live or other)? Yes ❑ No <br />'�Lsk SQ-chK.�S <br />