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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 /> Joe George 1926 - 72nd Street <br /> Name Address <br /> 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 /> Laurie LaMotte Park Ballfield 3 unless being used by Centennial Football then <br /> Soccer Fields 1 & 2 <br /> 3. What is the number of people that are involved in your event/activity? <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park Eagle Park <br /> Laurie LaMotte Memorial Park X Hidden Spring Park <br /> (Lighting & Warming House) Trailside Park <br /> An adult may be requested to take <br /> responsibility to lock & unlock restrooms <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 /> October 7, 2013 6:30 - 8:00 <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 /> Cub Scout Rocket Launch <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 /> 9 -24 -2013 <br /> Z d Perso i ' g Date <br /> Signafure <br /> Office Use Only <br /> Permit approved by: Date: k4jm <br /> Deposit required: $ iG a. ° Receipt # <br /> Form number: 2013.01 PU <br />