Fillable Application For Sound Permit KPD227 - Application for Sound

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Application For Sound Permit KPD227 - Application for Sound

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CITY OF KANNAPOLIS
North Carolina
APPLICATION
PERMIT FOR SOUND AMPLIFICATION
Code Section 11-25(c)
NAME:
ADDRESS:
TELEPHONE (DAY): TELEPHONE (EVENING):
NAME OF GROUP OR ORGANIZATION YOU REPRESENT (if applicable):
LOCATION WHERE AMPLIFIED SOUND WILL ORIGINATE (street address or exact location):
TYPE OF LOCATION WHERE THE AMPLIFIED SOUND WILL ORIGINATE:
Residential - Single Family
Residential - Multi-Family
Business Property
DISTANCE IN FEET TO NEAREST RESIDENTIALLY OCCUPIED PROPERTY:
IS THE LOCATION A PLACE OF PUBLIC ENTERTAINMENT?
YES NO
IF YES, WHAT IS THE MAXIMUM CAPACITY (Number of Persons):
HAS A PERMIT FOR ADDITIONAL AMPLIFICATION BEEN ISSUED FOR THIS LOCATION WITHIN THE
PAST TWELVE (12) MONTHS?
YES
NO
DATE OF PLANNED USE OF AMPLIFIED SOUND:
Note: Applications for a permit for additional amplification must be submitted at least fifteen (15) days
in advance of the planned use.
Other:
Church
IF YES, WHEN:
NATURE OF
PROPOSED
ACTIVITY:
TIME OF ACTIVITY: FROM
AM PM
UNTIL
AM PM
TOTAL NUMBER OF HOURS FOR WHICH PERMIT IS REQUESTED:
School
Note: Permits for additional amplification are limited to 20 hours per year at public places of entertainment
having a capacity of 1,000 or more persons, or ten (10) hours per year at any other location.
Provide the name of the person who will be in control of the sound amplification equipment and will
assure that its use complies with the terms of the permit. The responsible person must be available
at the site of the event during the entire time for which a permit has been issued.
DESIGNATION OF RESPONSIBLE PERSON:
KPD-227
Rev 10/02
Note: Permits may only be issued for events conducted between the hours of 9:00 AM and 9:00 PM, unless held
at a place of public entertainment having a capacity of 1,000 or more persons.
CERTIFICATION OF APPLICANT:
I hereby certify that the information contained in this application is complete, true and correct to the
best of my knowledge and belief. A copy of the Noise Ordinance has been provided to me and I
understand that I am responsible for compliance with its provisions.
I understand that upon the tentative approval of this application, I will be responsible for mailing or
otherwise delivering to the occupants of each property within a 500-foot radius of the location for
which the permit has been granted, written notice stating the date, hours, and nature of the event. I
understand that this notice must be delivered at least 72 hours in advance of the event. (NO
PERMIT WILL BE ISSUED UNTIL THE AFFIDAVIT OF MAILING OR DELIVERY IS SUBMITTED
TO THE NOISE CONTROL OFFICER).
Signature of Applicant
Notice of Tentative Approval:
Date:
$25.00 PERMIT FEE (Non-Refundable)
Permit fee received on
Date of Application
Notice of Application Denial:
Date:
Affidavit of Mailing or Delivery
of Notices Received:
Date:
POLICE USE ONLY BELOW THIS LINE
Application received on
Attachment: Call history at proposed activity location within the past 12 months
Attachment: Record of permits issued for the proposed location within the past 12 months
BY:
BY:
Date: Date of Permit Issuance
PERMIT APPROVAL
PERMIT DENIAL
SUBMISSION & PROCESSING
Date:
Appeal for Exceptional Permit
COMMENTS
State of North Carolina
CITY OF KANNAPOLIS
AFFIDAVIT OF MAILING OR
DELIVERY OF NOTICES
Sworn to and subscribed before me
the _____ day of _____________________20___.
My Commission Expires:
NOTARY PUBLIC
(SEAL)
THE UNDERSIGNED, first being duly sworn, deposes and says:
1. That this affidavit is made pursuant to the provisions of the City of Kannapolis
Noise Ordinance Section 11-25(c)(2) to induce the Noise Control Officer to issue a
Permit for Additional Amplified Sound.
2. That the undersigned or the undersigned's agents have mailed or delivered notice
to all parties entitled to notice pursuant to the above referenced provision of the
Kannapolis Noise Ordinance.
3. That a list of the street addresses of properties to which the required advance
notice was mailed or delivered is attached hereto.
This the ______ day of ____________________, 20____.
AFFIANT:
Signature
Print or Type Name
NOTICE OF APPLICATION TO OBTAIN
A SOUND AMPLIFICATION PERMIT
Dear Sir or Madam:
This form is to notify you that the person listed below has applied
to the City of Kannapolis for a sound amplification permit. City
Code requires that the applicant mail or otherwise deliver to the
occupants of each property within a 500-foot radius of the facility
where the sound will originate, a notice stating the nature, date,
and hours of the proposed event. This notice must be delivered at
least seventy- two (72) hours prior to the event. If you object to the
issuance of the requested permit, please contact the Office of the
Chief of Police at telephone (704) 920-4010.
Applicant Name:
Location of Event:
Nature of Event:
Date of Event:
Hours of Event:
DATE OF NOTICE
KPD-227
Rev 10/02
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Completed 13 July 2020

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