Special Event - E Monroe Block Party - August 3

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` `lJ %-I Ly U1 VUULII DCIIU JVMjd1 CYCI It PAPP111.dUU1I 2. Neighborhood Event • Y\ eucv :12 $25 application fee if filed 30 days or greater (up to 180 days) in advance of event iw:s i Please Bring Completed Application and Payment to: Public Works Service Center, 731 S. Lafayette Blvd., South Bend, IN Review the Instructions on the Special Events page before completing the application. Neighborhood Special Event applications must be submitted more than 30 days in advance of the event date or the application will not be accepted. Section A - Applicant Information Date of Application: "I �ZpI i'oZ( Organization Name: Applicant (Contact) Name: T7&1n aVA ky-' `1C&Q Applicant (Contact) Phone: �d 1S " ti1 b 03 ContactEmail: - V\e J C 11 eS 1 P �14AOVt ( I W"'l Address: H 11 e • MDA(DC ' iKrtkl- City/State/ZIP: Szuh- Secondary Contact Name: `kl le Contact Phone: S 10- N �� (q ContactEmail: 'IC�Ne J L t tf S Address: Nk �1/�lC� s t City/State/ZIP: S+T R 15Z.-IQ LA�JkotS • Section B - Event Information Event Name: �kOLk' r0� 2-1 Expected Attendance: Requested Street Closure: C. V V 1 OJT &) e ';V eet From (Cross Street): To (Cross Street): SJJL✓�+�5 Provide a brief description of the event: A iD cu k7�2 GPti CLZ .tom Date of Event Setup [mm/dd/yyl: 3 I .�ti� Time: ova Begin Date of Event [mm/dd/yyl: 5 1 g01'-I Time: 3 0-2 OVyx End Date of Event [mm/dd/yyl: q I "3 -Lo L`A Time: 1 " 0P v\ Event Cleanup Completion [mm/dd/yyl: \ 3 (vOtiy Time: Have all residents on the affected block have been notified and invited? XYes ❑ No is Please attach a copy of the door hanger or letter used to notify residents in addition to signature attachment. Number of households fronting the proposed street closure: Number of households represented by signatures on attached sheet: I (� ESL.