Fillable Assembly Permit Application (Town of Burns Harbor)

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Assembly Permit Application (Town of Burns Harbor)

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U.S.A. forms for Town of Burns Harbor

BROWSE TOWN OF BURNS HARBOR (IN) FORMS

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Revised May 2016
Assembly Permit Application
(Burns Harbor Ordinance 243-2011)
1240 North Boo Road Burns Harbor, IN 46304
P 219-787-9413 F 219-787-1353
jjordan@burnsharbor-in.gov www.burnsharbor-in.gov
Date:
Permit Number:
Zoning District:
Applicant:
Applicant’s Phone Number:
Applicant’s Age:
Name of Property Owner:
Property Owner’s Address:
Property Owner’s Phone Number:
Address of Public Gathering
Legal Description:
Location of Gathering on Property:
Program or Purpose of Gathering:
Maximum Number of Persons Expected to Attend:
Date of Event:
Duration:
First Day of Public Announcement, Promotion, or Advertising:
The following information must be attached to this application:
1. Food and drink facilities and providers thereof.
2. Sanitary and waste disposal facilities quantity and location as well as the providers thereof.
3. Transportation and parking facilities size and location.
4. Security and protection of surrounding areas, including specific reference to the number of security
personnel assisting in the control of traffic and supervision of those attending and providers thereof.
Note: Must have one (1) officer present for every fifty (50) persons present.
5. On-site medical facilities and providers thereof.
6. Janitorial services and post-gathering trash removal and site restoration and providers thereof.
7. Lighting quantity and other utility services location.
8. The number, location, and power levels of amplifiers and speakers, and the plans for sound control
during the assembly, if applicable, identifying the inclusive times during which music will be played or
loudspeakers will be in use.
9. Certificate of Insurance as required by Ordinance.
Revised May 2016
10. Statement containing names and addresses of licensed ticket printers to be used and the plans for
assuring the return of monies upon the termination or cancellation of the event, as well as the means of
notifying potential and existing ticket holders or vendors of such cancellation, when the anticipated
number of people attending is over 100 persons.
11. A list of adjoining property owners within five hundred (500) feet of the property intended to be used for
the assembly.
12. Examples of proposed advertising of the event.
13. Applicant’s statement that they shall abide by the terms and provisions of the Ordinance and all laws,
rules and regulations of the United States, County of Porter and Town of Burns Harbor.
** If the sponsor/applicant is a corporation; copies of Articles of Incorporation and Corporate Resolution
authorizing the application and names and addresses of a current board of directors and corporate officers
shall be attached to this application.
Fee Schedule:
Permit fee shall be based upon the following schedule:
Number of Attendees Permit Fee
More than 100 but less than 1,000 $100.00
More than 1,000 but less than 2,000 $200.00
More than 2,000 but less than 5,000 $300.00
More than 5,000 but less than 10,000 $400.00
10,000 or more $500.00
This application and applicable fee based on the above number of attendees are to be given to the Burns Harbor
Clerk-Treasurer. It must be received at least 45 days prior to the event. A copy of this application will then be
delivered to the Town Marshal, the Town Fire Chief, the Town Street Commissioner, and also to each Town
Council Member.
I hereby acknowledge that I have ready this application and state the above is correct and agree to comply with
all Town of Burns Harbor Ordinances and State Laws regarding Public Gatherings. I have been given a copy
of the Town of Burns Harbor Public Gathering Ordinance and understand all the provisions of this Ordinance.
Signature of Applicant Printed Name of Applicant Date
Signature of Corporate Officer Printed Name of Corporate Officer Date
Signature of Corporate Officer Printed Name of Corporate Officer Date
Signature of Burns Harbor Clerk-Treasurer Printed Name of Burns Harbor Clerk-Treasurer Date
Signature of Town Council President Printed Name of Town Council President Date
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Assembly Permit Application (Town of Burns Harbor)

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Completed 16 July 2020

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