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vu '4 Ic iu:1+08 uwuya►e, inc. 651 - 204 -9077 <br /> P.1 <br /> I <br /> PARK FACILITY PERMIT APPLICATION <br /> 1. Name/Address!Phone Number of Individual or Organization responsible for <br /> making this application: <br /> Christi Schreyer 6782 E. Shadow Lake Dr <br /> j Name Address <br /> 651- 407 -9169 Limo Lakes, MN 55014 <br /> Telephone Number City, State & Zip <br /> 2. Please describe your event/activity and identify the specific facility /field within <br /> the park you wish to use along with what you are asking from the City; <br /> Use hockey rink for dryland training for cyha C Squirt team. <br /> 3. What is the number of people that are involved in your eventiactivity? 16 <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park Eagle Park <br /> Laurie LaMotte Memorial Park Z Hidden Spring Park <br /> (Lighting & Warming House) Trailside Park <br /> Cornerstone Park Royal Meadows Park <br /> Tracie McBride Memorial Park City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> 10/27/12 @11 a.m. <br /> 6. Is anyone charged a fee to watch or participate in your event? No <br /> 7. Have you used these facilities before? No if so, when? <br /> 8. Are you requesting additional permits or City services? Yes No <br /> (i.e., Road Closure(s), Temporary Liquor License(s), Fireworks Permit or <br /> Burning Permit, U-w of lights, bathrooms or poria- polries, Park Buildings) <br /> Please describe NO <br /> Depending upon the nature of your event, or if you are requesting City services, you may <br /> be required complete a different application and/or make a deposit to cover city costs. <br /> Chri sti Schreyer <br /> 10/24/12 <br /> n of Pcr n Signor Dat <br /> i <br /> i <br /> Signature <br /> -------- - - - - -- ------------------------- <br /> ---------------------- -- - - - - -- <br /> Office Use Only <br /> Permit a roved Date: /0 <br /> Deposit required: S - Rc4=ipt <br /> Form number; 2012.04 PG <br />