|
<br />
<br />Anoka County Parks and Recreation
<br />
<br />-
<br />
<br />550 Bunker leke Boulevard NW. Andover. MN 55304
<br />
<br />SPECIAL USE PERMIT REQUEST FORM
<br />Todoys Dote: 9/1 () / of) Date of Event: fJ /0 S,/ 0 1
<br />
<br />Perk: R /(t! ell'/;-.::4 (' iI-I) Of; <'r Lrllo:)'
<br />
<br />i?<:-$,O.u.1L P,'H'" . .
<br />Arrival Time: _ Departure Time: I 0; ",.
<br />/7' 0.,<.....' -
<br />r..:.:.11/1'1,/TI:Y (,t7 ty; CL.~7};;I?j,'ILL,-
<br />
<br />Pavilion/Shelter/Meeting Room Number or Name:
<br />NameofOrgcnization: Ft~t:h J-lh-rflel11Je;.;;
<br />Contact Name: f~iT/?lLt( l]i~.1A..:c.ti
<br />Address: i~. i fi 1/u1VTJ;:Y/f 1(/ d.,t.. L'l ,"it.
<br />v
<br />
<br />Phone Number: Home: ( 70] ) 50/-b:!iS' Work: '-----J
<br />Number of People Attending your Event: --::3.00
<br />
<br />. I: ';/V try( i...,ltc
<br />City: l..
<br />
<br />Zip:
<br />
<br />?-5.c]H
<br />
<br />Fox: L--...)
<br />
<br />Requested Spadel Use Activity (pleose describe speciel activity requested end location of activity as it reloles to reseNed
<br />shelter/pavilion/meeting roam): '171~ €.v'u...f j!> C~".f"'I',L4: ~ 'P,r.sT /1.L:No.!",L Sir lJfkr::'
<br />IcU/v;l Add j",' ;J~~C~,,) h~..." ",,-,.n AT. J, 1-/lc~ 01, !fv...,.1._"TJ'J /W,1Lt.-..7JJ
<br />u."tL i!,.d",,' "t aN CS,.jH 14 !J'lt... ,l""~ >i.j...t ,,,,,it. .1-,1--. <.,ri. ;:!1-t?~
<br />~ ...;...LL S'tr L'P 71.<-,,: ~'.Ih-.... r,;h1n<l.V\' I'" Rd'!:.- C,7c.?i'J" p.w"
<br />
<br />Specific Time Special Use Activity Will Take Place in Perk:
<br />
<br />Indicate Additional Set.Up and Take-Down Time (If beyond reseNCtion hours): 1'~ i ~fJ 06(;.-: - "}.'O('
<br />,(,') Tn~' <!.,_"", /(,,'(..)- iC:;J~ ~
<br />Does Activity Require Electric Hook-Up? Yes -{,~ How many? _ Does ActivIty Require Water Hook Up? Yes ~
<br />
<br />08;(10 --/0:00 ,1"'1
<br />
<br />For Office Use
<br />
<br />_ Approved
<br />
<br />_ Not Approved
<br />
<br />Additional Fees
<br />_ Tent ($25 )
<br />_ Maintenance Fees ($25 / hour)
<br />Other
<br />
<br />Approved by:
<br />
<br />Tille:
<br />
<br />Date:
<br />
<br />Revised 7/25/07 dh~ ReWed 812107 md. ReWed 10/18107 md
<br />
<br />OPEN SPACES IN NEARBY PLACES
<br />
<br />Phone: 763.757.3920
<br />
<br />www.anokacauntyparks.com
<br />
<br />Fox: 763.755.0230
<br />
|