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PARK FACILITY PERMIT APPLICATION <br /> 1. Name /Address/Phone Number of Individual or Organization responsible for <br /> making this application: <br /> Centennial Soccer Club Bri Nelson 1747 Meadow Lane <br /> Name Address <br /> 651- 247 -5286 Centerville, MN 55038 <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 /> Open grass areas of. a) Acorn Park, South area; b) Laurie LaMotte Park, <br /> Southwest corner (south of skate park & west of BB fields); <br /> c) Laurie LaMotte Park, northwest corner (east of parking & west of BB fields) <br /> 3. What is the number of people that are involved in your event/activity? 50+ <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park ✓ Eagle Park <br /> Laurie LaMotte Memorial Park Hidden Spring Park <br /> (Lighting & Warming House) Trailside Park <br /> Cornerstone Park IT Royal Meadows Park <br /> Tracie McBride Memorial Park F City Hall <br /> 5. Please list the date or dates and times you propose to use the facilities: <br /> Summer 4/1 - 7/26 5:30pm to Sunset; Fall 8/1 - 10/30 5:00 pm to Sunset <br /> 6. Is anyone charged a fee to watch or participate in your event? No <br /> 7. Have you used these facilities before? Yes If so, when? <br /> Previous 5+ summers and fall. <br /> 8. Are you requesting additional permits or City services? Yes x No <br /> (i.e., Road Closure(s), Temporary Liquor License(s), Fireworks Permit or <br /> Burning Permit, Use of lights, bathrooms or porta potties, Park Buildings) <br /> Please describe <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 /> Brian L. Nelson 1/22/13 <br /> Printed �Name J of / Person Signing Date <br /> Signature <br /> ------------------------------------------------------------------------- <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Form number: 2012.04 PU <br />