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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 />Beth Wielinski P.O. Box 475 <br />Name Address <br />651-271-9962 Circle Pines, 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 />Soccer Practices -Mondays 5:3-7:30; Tuesdays 6-8pm <br />Wednesdays 5:3-7:30; Thursdays 6-8pm-Lamotte Park <br />April 1 lth-July 15th; August 15-October 14th <br />3 <br />4 <br />5 <br />What is the number of people that are involved in your event/activity? <br />What City facilities do you wish to use <br />Acorn Creek Park <br />Laurie LaMotte Memorial Park <br />(Lighting & Warming House) <br />An adult may be requested to take <br />responsibility to lock & unlock restrooms <br />Cornerstone Park <br />Tracie McBride Memorial Park <br />Eagle Park <br />X Hidden Spring Park <br />Trailside Park <br />Royal Meadows Park <br />City Hall <br />Please list the date or dates and times you propose to use the facilities: <br />Aprit I Ith-July 15th; August 15-October 14th <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 />last fall <br />8. Are you requesting additional permits or City services? Yes X No <br />(i.e., Road Closure(s), Temporauy 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 />Beth Wielinski <br />Printed Name of erson Sid *ng <br />3.30.22 <br />Date <br />Signature <br />.......................................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 <br />Office Use Only <br />Permit approved by: <br />Date: <br />Deposit required: $ <br />Form number: 2013.01 PU <br />Receipt # <br />