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DRAFT CityofCentervilleRecreationalUse VehiclePermit <br />ApplicantName:______________________________________________________________________ <br />Street/MailingAddress:________________________________________________________________ <br />Phone(day):________________Phone(cell):___________________________ <br />Address of Parked Vehicle <br />Model_______Color______ <br />Make_______________ <br />LicensePlate#________________ <br />Proof of Insurance <br />InsuranceCompany(notagent)___________________________ <br />Policy#___________________PolicyPeriod: <br />From_____When____ <br />Duration of Stay(Describethedurationofyourstay). <br />**Maximum stay per calendar year is 14 days. <br />Asanapplicantforthisspecialuserecreationalvehiclepermit,Iagreetothefollowing: <br />1.IunderstandthatallpersonsshallcomplywiththeprovisionsoutlinedintheTemporary <br />DwellingsOrdinance §156.104andthatviolationofsuchtermswillresultintherevocationofthe <br />permit,andthevehicleshallberemovedimmediately. <br />2.IunderstandthattheCityofCentervilleassumesnoliabilityforanyinjuriestopersonsor <br />propertywhichmayresultfromtheparkingofarecreationalvehicleattheaddresslisted <br />above. <br />ApplicantSignature__________________________Date_____________ <br />Bycompletingtheaboveapplicationandprovidingyoursignature,youagreethatyouhave <br />reviewedandunderstandallregulationsinthecityofCentervilleCityCode,Chapter §156-104 <br />Temporary Dwellings and that all information in this application is true and correct. <br />\] <br /> <br />