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C�C) <br /> PARK FACILITY PERMIT APPLICATION <br /> 1. Name/Address/Phone Number of Individual or Organization responsible for <br /> making this application: <br /> Nicole Carlson 7058 Eagle Trail <br /> Name Address <br /> 651-245-8006 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 /> LaMotte Park - pavilion/picnic area. Event will be a picnic for 1 st grade boys <br /> flag football team and their families. <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 /> Sunday, September 28 from 4-8pm <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? X Yes 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 Use of bathrooms and porta-potties, if they are no additional charge <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 /> Nicole R. Carlson 9/22/2014 <br /> Printed Name of Person Signing Date <br /> Nicole R. Carlson ° <br /> Signature <br /> .NNN8NnEEEEaNNff a ...................................................... <br /> Office Use Only <br /> Permit appro y:- Date: <br /> Deposit required: $ Zoo. /� =4/ Receipt# <br /> Form number: 2013.01 PU ���� <br />