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• ATk _ . City of South Bend Special Event Application <br />x 3 n, �. <br />Neighborhood Event <br />$25 application fee if filed 30 days or greater (up to 180 days) in advance of event. <br />Please Brine Completed Application and Payment to: <br />Public Works Service Center, 731 S. Lafayette Blvd- South Bend, IN <br />Review the Instructions on the Special Events page before completing the application. Neighborhood Special <br />Event applications must be submitted more than 30 days in advance of the event date or the application will not <br />be accepted. <br />Section A - Applicant Information <br />Date of Application: 6T L l" Z `t Organization Name: <br />Applicant (Contact) Name: 1��� � C_(, A S �� Q '2N, S %� <br />Applicant (Contact) Phone: CigU �7 4j �n �O$ctEmail: `p 'M� e Z `—� 9��'LA C'"��� <br />Address: 8LZ (-1Clj 1_)F Q RUB_ City/State/ZIP: SOUTH N"Yrr L.s� 10 (Ato(o L(p <br />Secondary Contact Name: \ ►A C <br />Contact Phone: `L q b S �(p l � Contact Email A 1y\N _A E (-x 1 (,AoA Ma/� cow) <br />Address: CLZ City/State/ZIP: S nIT� ���� • \� y�t� 1 (W <br />_ Section B - Event Information <br />I Event Name: ' �� S 1) �-1 � "•� � � EzpectedA[tendance: IS <br />Requested Street Closure: 1 i \ V'ETZ__ S\ <br />From (Cross Street): i c� L_'nGc13 R V Iz[ <br />To (Cross Street): C)C>7 C-i oCD-!- <br />Provide a brief description of the event: <br />Date of Event Setup [mm/dd/yy]: Olp,� - ` 1 Z OZ Lyme: Z <br />Begin Date of Event [mm/dd/yy]: Dg - 0- <br />Zn2 f,"/rLime: <br />End Date of Event [mm/dd/yyI:�ZCn" L l LZLZ Time:y �M <br />Event Cleanup Completion [mm/dd/yyl: Time: <br />Have all residents on the affected block have been notified and invited? ❑ yes [XNo <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: <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? ❑ yes *No <br />