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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 /> Rachel Hagerty 2083 Willow Circle <br /> Name Address <br /> (651)276-4806 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 /> We would like to use the picnic shelter at Lamotte park closest to the <br /> ball park and playground area for our son's 5th birthday party. We would like to <br /> also have access to the bathrooms if possible. <br /> 3. What is the number of people that are involved in your event/activity? 35 <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) x Trailside Park <br /> An adult may be requested to take <br /> responsibility to lock&unlock restroomss <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 /> Saturday June 13th from 12pm- 6pm. <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 /> We have been to various Lions events here but have never rented it before. <br /> 8. Are you requesting additional permits or City services? x Yes No <br /> (i.e., Road Closure(s), Temporary Li uor License(s), Fireworks Permit or <br /> Burning Permit, Use of lights, athro ns or porta potties, Park Buildings) <br /> Please describe we would like to be able to use the rest rooms connected to warming hot-j-Se. <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 /> Rachel Hagerty 5/28/15 <br /> Printed Name of Person Signing Date <br /> �7 <br /> Signature <br /> Office Use Only <br /> Permit approved by: Date: <br /> Deposit required: $ 10b,60 ,(� Receipt# /D 71/Z., <br /> Form number: 2013.01 PU �q <br />