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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 Youth Football 4335 Pheasant Ridge DR NE_ <br /> -7 - Address <br /> 65216 -3664 (Brian Sauer) �` , , #224 -122 Blaine, MN 55449 <br /> Telephone N -- �.: , 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 /> Requesting Football Practice Fields and LaMotte Park for next year (2014) <br /> Looking for fields if 1 and #2 on LaMotte Map <br /> 3. What is the number of people that are involved in your event/activity? 100 <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 & Wanning House) Trailside Park <br /> An aduk may be requested to take <br /> responsibility to lock & unlock restrooms Royal Meadows Park <br /> Cornerstone Park City Hall <br /> Tracie McBride Memorial Park y <br /> 5. Please lis the date or dates and times yoLZ pose to pse the facilities: <br /> August- Octo 2014 - 5PM -8PM ' :�a' , � ° t-rt� <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 /> 2013 <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 ports 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 Sauer 8/14/13 <br /> Printed Name of Person Signing <br /> Date <br /> S i g n as u i r ir arr�rrsr��arrrarrrrrrr� sarar � a �� rr �� rrar � ra ��� ra ��� RR � asss �� sw � ■ <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt # <br /> Farm number. 2013.01 PU <br />