Water Wall Park
Application for Special Use Permit
Date
Applicant Information
Name
Address
City State Zip Code
Phone # Alt. Phone #
E-mail Address
Use Information
Organization
Non- Profit For Profit
Date Requested Begin Time End Time
Estimated Attendance
Type or Purpose of Public Gathering
Type of Sound system to be used (if any)
(Please note that a separate Permit is required for the use if sound systems)
Special Effects or Features
Does the requested use include any of the following (Check "Yes" or "No" - any blanks will be assumed to be a "Yes"):
The sale or distribution of food, drink, or merchandise:
Yes No
Admission Fees or other charges to attendees:
Yes No
Sale or promotion of commercial products or services:
Yes No
Yes No
Performances for the primary purpose of
entertaining an audience:
Certification and Acknowledgement: The undersigned does hereby certify that the information contained in this application is
true and correct, and acknowledges that if any of the information is found to be incorrect, this permit can be revoked. The
applicant confirms that they will clean up and remove all litter and debris generated by the Public Gathering. Further, it is agreed
that the applicant will pay any User Fees associated with the Public Gathering, including fees for any fencing provided by the
Administrator necessary to protect adjacent Park Areas NOT designed or maintained to accommodate Public Gatherings.
Applicant Signature Date
Official Use Only
Date/Time Received
APPROVED:
Yes No
Signature
Do have special set-up
requirements (e.g. Tables,
Chairs, Tents, etc)?
NoYes
Do you understand that there
are no rest rooms available at
the Park?
NoYes
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signature
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signature
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