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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 />1668 Hunters Trl <br />Brian Peterson <br />_______________________ _________________________ <br />Name Address <br />6517937432Centerville, MN 55038 <br />_______________________ _________________________ <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 />Scout BSA Troop 136 Award Ceremony and Picnic <br />_________________________________________________________________ <br />_________________________________________________________________ <br />_________________________________________________________________ <br />100 <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 _____ Eagle Park _____ <br />X <br />Laurie LaMotte Memorial Park _____ Hidden Spring Park _____ <br />(Lighting & Warming House) _____ Trailside Park _____ <br />An adult may be requested to take <br />responsibility to lock & unlock restrooms <br />Cornerstone Park _____ Royal Meadows Park _____ <br />Tracie McBride Memorial Park _____ City Hall _____ <br /> <br />5. Please list the date or dates and times you propose to use the facilities: <br />Thurs, June 26 from 5 PM - 9 PM <br />_________________________________________________________________ <br />N <br />6. Is anyone charged a fee to watch or participate in your event? _______________ <br />Y <br />7. Have you used these facilities before? ______ If so, when? <br />Last Year <br />__________________________________________________________________ <br />X <br />8. Are you requesting additional permits or City services? _____ Yes _____ 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 />Brian Peterson6/4/2005 <br />_________________________________ __________________ <br />Printed Name of Person Signing Date <br />_________________________________ <br />Signature <br />Office Use Only <br />Permit approved by: __________________________ Date: __________________ <br />Deposit required: $______________ Receipt # _______________ <br />Form number: 2013.01 PU <br />146 <br /> <br />