Street Closure - Linda Riley - Laserfiche WebLink

Home Browse Search

A APPLICATION FOR USE OF AND BLOCKING OF ACCESS TO PUBLICl��F7L RIGHT-OF-WAY FOR A RESIDENTIAL BLOCK PARTY :1:7xyu*En_r� V The Board of Public Works must have four (4) weeks prior notice of the event. A NON-REFUNDABLE APPLICATION FEE OF $50.00, IN THE FORM OF A CERTIFIED CHECK OR MONEY ORDER, PAYABLE TO THE CITY OF SOUTH BEND, MUST BE �\ INCLUDED WITH APPLICATION. Applicant Name: ij f - Organization: qq ' ra (i% f .. J`� f� S4_e �__ i C � 1'5 /'�� 6 w City: Stater V Address: /- } Phone: Email: Secondary Contact f ,ice_ 4f rs � ckcj l Address: City: State: .— Phone: -7-ramC j-�3 Email: e ; s C7 c ev cam( This application is made to the City of South Bend, Indiana, Board of Public Works, for the of the specified public right-of-way by Applicant for the holding of the hereinafter described event: Event Name Name of Street Closure Street - From -A,0 v To . Date of Event /X 20 0 Time Setup 101'6<j ❑a.m. ap.m. Start '`: ❑a.in.Dip.m. End - ❑a.m . El m U Cl Time Approximate Number of Attendees Please answer the following appropriately: • This event will be open to residents outside the immediate ❑ Yes No neighborhood. • All residents on the affected block have been notified and invited. A ER Yes ❑ No copy of the flyer distributed is included. _P • There is/are resident(s) affected by the event that may need ADA ❑ Yes No transportation assistance to their residence. • This event will have music (live or other). Yes ❑ No • Payment of $50.00 fee payable to City of South Bend included Yes ❑ No 1 CCO7 C c�1 1 . GOcn Sys' Updated 08/2017