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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 />Chris Otto <br />Name <br />651-274-7729 <br />Telephone Number <br />1836 Old Mill Court <br />Address <br />Centerville, MN 55038 <br />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 athletic field at Acorn Creek Park for flag football <br />practice on Wed. and Thurs. from 6pm-7pm starting the week of Aug 28th <br />through mid Oct. <br />4. <br />7 <br />What is the number of people that are involved in your event/activity? 15-20 <br />What City facilities do you wish to use <br />Acorn Creek Park X <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 />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 />Wed. & Thurs. from 6pm - 7pm starting the week of Aug 28th through mid Oct. <br />Is anyone charged a fee to watch or participate in your event? No <br />Have you used these facilities before? Yes If so, when? <br />my kids play on the plavaound frequently. <br />Are you requesting additional permits or City services? Yes X No <br />(i. e., Road Closure(s), Temporary 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 />Chris Otto <br />Printed Name of Person Signing <br />ChrisOyyO Digi1311y 5k2-d by ChMOft <br />Otto Date: 2073.08.23 12:25,24-d5'✓)0' <br />8/23/2023 <br />Date <br />Signature <br />■rrrr�rrrr�rrrrrrrrrrrrrrrrr■■rrrrrr�rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ <br />Office Use Only <br />Permit approved by: . <br />Deposit required: $ <br />Date: <br />Receipt # <br />Form number: 2013.01 PU <br />