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APPLICATION <br />The Board of Public Works must have four (4) weeks prior notice of the event. 'sb' (1 <br />A NON-REFUNDABLE APPLICATION FEE OF $50.00, IN THE FORM OF A CERTIFIED <br />CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE �� <br />INCLUDED WITH APPLICATION.11z, <br />f, ! I . "J <br />Applicant Name: <br />Address: 1 �?," <br />Phone: <br />This application is made to the City of South Bend, Indiana, Board of Public Works, for the use of the <br />specified public right-of-way by Applicant for the holding of the hereinafter described event: <br />Event Name zfl(i/G 5(Jziged < �Gr <br />Street Closure Name of Street a Ui Q <br />\ <br />From �SG'P �%'/,t�� 1 <br />To <br />Date of Event S'� pj 20 <br />Time Setup _ ❑a.m. (p.m. Start Elam. [Wm� End ❑a.m. <br />U✓ p.m. <br />_ <br />Approximate Number of Attendees <br />Please answer the following appropriately: <br />• This event will be open to residents outside the immediate neighborhood. L2 Yes <br />❑ No <br />• All residents on the affected block have been notified and invited. A copy ❑ Yes <br />❑ No <br />of the flyer distributed is included. <br />• This event will have music (live or other). Yes <br />❑ No <br />• Payment of $50.00 fee payable to City of South Bend included Yes <br />❑ No <br />IF ALCOHOL IS TO BE SERVED OR SOLD <br />Alcoholic beverages will be served ❑ Alcoholic beverages will be sold ❑ <br />Certified Check or ney Order for $400.00 must be submitted with application. <br />• Application canno a processed without deposit. <br />❑ <br />• Deposit will be returne pon inspection of event area by the Board of Public Works. <br />Names and phone numbers of E security guards <br />• To monitor underage drinking. <br />❑ <br />• Qualifications must be listed (e.g. -duty police officer, professional security guard, or event <br />APPLICANT). <br />A drawing must be submitted showing: <br />• Fencing around serving area <br />❑ <br />• Trash receptacles. <br />o Ample trash receptacles must be provided to ens proper disposal of refuse. <br />Temporary liquor license. <br />• Call the Alcohol & Tobacco Commission at (317) 234-4315 for more' ation. <br />❑ <br />• Application cannot be processed without a copy of this license. <br />Updated 6/25/12 <br />1 <br />