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<br />Ap r. 21. 2006. 3: 02PM <br /> <br />No. 6193 P. 4 <br /> <br />WiD fboc18Dd1ornoJHllcohoJic bevcmgcs be served? Yes \ <br /> <br />No <br /> <br />If,., desadbe sanitation ~ food hA1\dlrng procedates m;ltl:lc nature oftb.e food (sacb as <br />pxe..peohpt foods, hot dogs, pre..mfxed sodS, unpee1ed bit, mw 1I18IdS.. vegetables, fish 01' <br />peeled and cut:6:a.it.) <br />'(~ &v..lt ~AnJ&LJ Ii. A*MorJlJ/) ~/~ .411fhldJ.. <br /> <br />'II ~ 1811 will.. a. DermIt from. the A." CoImtv ~t at'..;EJidroll~1 <br />HeaIt1I.~,-~ I.R1!l ofth(l]JpittJJt1dR .,~ <br /> <br />9. SBCuluTY AND SAmrY PROCEDURES: .. <br /> <br />Descrlbe your Pl'6~ ~\Wi;Ij tor set ~ opam1ioa. i1\fM'M' securl1y aG.d ctOwc1 control: _ <br /> <br />If1ho event is 1:0 cx::curBt Dight, descrl.be how you am going to Hgbt the eve,ut .. fa Older to <br />iuca:c=ue tho BfIfeLy. ofparficipmts and spectators comicg to anct I-viDa the mmt: . <br /> <br />If your event inoludes whicles or ~I~- clesoDbe the minimum and ",~~ speeds of the <br />event and the ~mimnm and mmrmnn iD.te.rva1s ofs,Page to be -tabled between \1Dits: n <br /> <br />o/~ <br /> <br />, <br /> <br />Attach to this appHcation a copy of)'OUl' building pc:anit(s) if you are iDstalHr1g illY eleCtrical <br />wiring on ttipv~1:U.1 or pennanent ~ and/or if you are buQd.Wg UI.Y tem.po1'1;(Y or pennanent <br />Lihuutww such IS bleacnem, scaffolding, a~ staps or platfouns. <br /> <br />Attach fA copy of~1ire department pennit(s) to this application if you will,. pam4e floats; <br />an ope:n flame; fireworks 01' pyrotechniCS; vobiole fbeli cooIdng filc.Uitlcs; enclosures (and tables <br />withm those closures): tents, air supported stmcturcs,canopies, or fi1bric shelte1'8. <br /> <br />Give tbo name, ~ m4 phone mmtbers otthe ageocy or a.geAdos Which wiD provide ~ aid <br />staff and equipmct ifzequked. Attach additional &beets ifnecessa:ry. <br /> <br />. <br /> <br />Name ofagenoy: <br />Name ofRGpresentative:. <br />AddIe5s: <br />Day phone: BveDing phone: <br />Tndic!sQ medical services Qrrequbd) that will be provided fbr this event <br /> <br />Page4ofl0 <br /> <br />13 <br />