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—Fe. r1e, s o <br />e,,,ai j <br />4, �+ <br />CferA4- PARK FACILITY PERMIT APPLICATIONS 1, <br />v <br />1. Name/Address/Phone Number of Individual or Organization responsible for <br />7c�lo making this application: <br />Jenny Deziel 6901 lamotte drive <br />Name Address <br />" i�, f 63-226-3291 Lino Lakes MN 55039 <br />Telephone Number City, State & Zip L <br />2. Please describe your event/activity and identify the specific facility/field within <br />[he park ou wish to use along wit from the City: <br />' 20B CrmavIle r" ° i airy ned'a7lion lnsa plan to hide fhe R iiiai at lammeD �- oad a ff llmt is ok. <br />+ ti OLD ct L k <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 <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 />Eagle Park <br />yes j Hidden Spring Park <br />Trailside Park <br />Royal Meadows Park <br />Tracie McBride Memorial Park City Hall <br />5. Please 11st the date or dates and times ropose to use the facilities: <br />6. Is anyone charged a fee to watch or participate in your event? No Free event <br />7. Have you used these facilities before? yes If so, when? <br />last year centerville hid the medallion under the picnic table at hidden springs park <br />8_ Are you requesting additional permits or City services? Yks nO No <br />(i.e., Road Closure(s), Temporary Liquor License(s), Fireworks Perrria]�+ <br />Burning Pennit, 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 />Jenny Deziel <br />1/26/23 <br />Printed Name of Person Signing Date <br />S ature <br />rr_■■rrrrrrrr�rrrrrrrrrrrirrrrrrrrrrrrrrrrrrrarrrrrrrrrrrrrrrrrrrrrrrrr■ <br />O ice Use Only <br />Permit approved by: — — — _ Date: <br />Deposit required: $ _ Receipt # <br />Form number. 2013.01 PU <br />