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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 /> Matt Koehn (Centennial Sac 649 Arlo Lane <br /> Name Address <br /> 651-336-1854 Lino 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 /> Acorn Park- South area(open field). <br /> LaMotte Park- 1,2 and 11 areas on the attached map. <br /> This is for the Centennial Soccer Club practices and Developmental programs. <br /> 3. What is the number of people that are involved in your event/activity? 25+ <br /> 4. What City facilities do you wish to use <br /> Acorn Creek Park X 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 /> Summer 4/1/15 - 7/31/15 Fall 8/1/15 - 10/30/15 (5 pm to sunset for both seasons; <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 /> We have used them for the past 6 summers and fall seasons. <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 /> Matt Koehn 1/13/15 <br /> Printed Name of Person Signing Date <br /> Signature <br /> ......................................................................... <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ Receipt# <br /> Form number: 2013.01 PU <br />