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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 />�IPoiSj <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 C —_ 1_ G (�� I <br />Date of Application: CS ' ZO ' ol09.5 �n Organization Name: C �k 5d0oc)u1s Nildm� <br />Applicant (Contact) Name: f 2,n oQ;i Wr IQ � ' . J , i <br />Applicant (Contact) P5 nne: �7`I 1 - 4 9,50 Contact Email: W 1U • Qi�� Q 10 L�� • C� <br />Address1U 0 S MCYt�oQn City/State/ZIP: �\ d _13 YLOU14 <br />Secondary Contact Name: <br />Contact Phone: <br />Address: <br />• Event Name: CH�Ia iQ lJ�� <br />Requested Street Closure: ACVI(�G <br />J <br />From (Cross Street):-�km micwil <br />To (Cross Street): <br />Provide a brief description of the event: <br />E <br />Email: <br />a <br />1�f17i7=��iSifiS - <br />Attendance: 150 <br />CJraY-d CytO1YIA -FAY �a� ca,�re� WN)iI Inave.. <br />a �ouncQ h��-S _ <br />Date of Event Setup [mm/dd/yy]: I y VIU IXI ' i jV jJ Time: <br />Begin Date of Event [mm/dd/yy]: ¢-� a Time: <br />End Date of Event [mm/dd/yy]: MCA" I C) � � ) Time: <br />Event Cleanup Completion[mm/dd/yy]: )`25Time: <br />Have all residents on the affected block have beers notified and invited: <br />r� <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: O <br />Number of households represented by signatures on attached sheet: <br />Will this event have music (live or other)? V Yes ❑ No <br />