Fillable LARGE GATHERING APPLICATION (Minnesota Department of Revenue)

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LARGE GATHERING APPLICATION (Minnesota Department of Revenue)

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LARGE GATHERING APPLICATION
Stearns County Environmental Services Department
http://co.stearns.mn.us/Environment/FoodBeverageandLodging
Administration Center Rm 343 - 705 Courthouse Square - St. Cloud, MN 56303
320-656-3613 or 1-800-450-0852 - Fax 320-656-6484
Applications must be received at least 60 days in advance of the event
2019 Fee:
$850.00 New Event
Application Received:
$400.00 Renewal
Receipt Number:
Name of the Event:
Hours:
Applicant Name: (Business, Partnership, LLC, Corporation)
Business Name:
Address:
City:
State:
Zip:
Applicant Name:
Address:
City:
State:
Zip:
Property Information where event will take place:
Property Owners Name:
Parcel ID Number:
Property Address (if different than above)
Street:
City:
State:
Zip:
The above information shall be provided for all the applicants, all partners if the applicant is a
partnership or corporation. (Attached additional pages if needed)
1.
Provide the Following:
Legal Description of the property where the event is to be held
Copy of Deed (if applicant is property owner) or
Notarized Statement from property owner giving permission to use property for the
event
Site Map indicating location of food vendors, fencing, parking, administrative control
center, toilets, and refuse/recycling containers
2.
Describe all of the activities anticipated to be a part of the event:
(Ex. Petting Zoo, Breakfast, etc.)
3.
Maximum number of participants expected Daily (including campers)
4.
Maximum number of tickets that will be sold
5.
Are there plans to limit the maximum number of attendees?
6.
Bond Requirements – A $25,000 license or permit bond is required. This bond shall be in
effect the first day of the event and shall terminate no sooner than the last day of the event.
7.
Insurance Requirements – A certificate of Insurance (Special Events Policy of Insurance as
described in section 5.2 of Ordinance # 254.
8.
List plans for providing fencing or barriers at the location of the event (including a site map
with fencing location) (Section 5.4)
9.
List plans for noise control. (Section 5.5)
10.
List plans for providing adequate toilet facilities (Section 5.6) the source, numbers, type and
means of disposal.
11.
List plans for collection, holding and proper disposal of Solid Waste (garbage) (Section 5.7)
12.
Recycling containers are required at Large Gathering Events. Please contact Tim Oswald at
Stearns County (320-656-8608) to obtain the necessary containers.
13.
Submit a plan and diagram for onsite parking. If parking will be off site, provide location and
address. Parking (Section 5.8)
How will traffic be controlled?
14.
Required plans for the Administrative Control Center (Section 5.9)
a. One operational weather emergency radio shall be provided.
b. Attach written plan for monitoring severe weather, procedure for notifying attendees,
and what recommended action will be provided.
c. Telephones (Section 5.16.2)
15.
List plans for providing Medical Services in accordance with Section 5.10 of the Large
Gathering Ordinance
16.
List plan for providing Security at the event (Section 5.11). The Stearns County Sheriff’s
Office can modify these requirements and provide law enforcement personnel as deemed
necessary.
Will gambling activities and/or alcoholic beverages be permitted at this event?
17.
Submit a fire protection plan, including signature of approval from your Local Fire Chief
(Section 5.12)
18.
Will your event include camping? If so, include a map and plans to address requirements listed
in Section 5.13 and 5.14 of the Large Gathering Ordinance.
19.
List plan for providing lighting if event continues during hours of darkness (Section 5.15)
20.
All Large Gatherings that use water for drinking, cooking, or hand washing, need to obtain their
water from a well that has been tested for Nitrates and Coliform Bacteria. Submit water test
results (taken within the past 12 months) with this application (Section 5.16)
21.
Provide a list of food vendors who will be allowed to operate on the grounds including names,
addresses and license numbers. All vendors serving food need a license from Stearns County
Environmental Services. Call 320-656-3613 to obtain license applications and requirements.
22.
Provide a written statement of approval from the local unit of government (Township).
I certify that the statements contained therein are true and correct to the best of my knowledge.
Applicant’s Name (printed)
Applicant’s Signature
Applicant’s Name (printed)
Applicant’s Signature
The following information is considered private data and will be treated as such
Applicant’s Name:
Applicant’s Address:
Applicant’s Social Security Number:
Applicant’s Minnesota Tax ID Number (if applicable):
Applicant’s Name:
Applicant’s Address:
Applicant’s Social Security Number:
Applicant’s Minnesota Tax ID Number (if applicable):
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LARGE GATHERING APPLICATION (Minnesota Department of Revenue)

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Completed 18 July 2020

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