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Tiry <br />HENNEPIN COUNTY SHERIFF'S OFFICE Council <br />WATER PATROL UNIT Exhibit B <br />SPECIAL EFEAT PERMITAPPLICA 77ON <br />camot be issued without the <br />wn"n PM—=Bslon is E!9!9� from the cLty or cities in which this mrad is to be held, <br />The inswance certificate mut show Hennwin Cougtv as an additiong <br />TUe following information is necessary to inw= the proper and accurate issuance of your pertnit. <br />Please complete this form in its entirety and return the gdgkud.&MLto our ofnce at 4141 Shomine <br />Drive, Spring Park, MN 55384, at least thfjU Q01 days prior to your event. (Faxed/scanned copies <br />of the liability release and this application are not sweptable.) <br />Please PRINT ar TYPE <br />NAMEOFEVENT: LL9C czi—�� Coate -6 -'Ow 1pe-e--C-tsc-e- <br />DAMS) OF EVENT:Aptii iv an if -x ca 4 <br />TMM(S) OF EVENT: S-.0- -L� 4"., <br />" -ttmwio u4A.. 0 CJ. !r I , <br />EVENT LOCATION: (A diagrarn should be included for larger events.) a e- - <br />sj=;rM am - iWak §�Rn a firiab, Imetiou <br />WAS THIS EVENT HEILD LAST YEAR: YES 9 <br />SPONSORING ORGANIZATTON: <br />CONTACT PERSON: <br />�M <br />ED <br />Ctv'j <br />DOB: <br /> - <br />ADDRESS: 9. 1 V-A W <br />4-0� LA kL ^j S-%-3 %-to <br />Sam Addrm — - —cifty SuKe ZIP <br />PHONE: Z -9q S - q 170 (012-8,50-SlAiL <br />C*Adklm 31&;U Wcwk COIL <br />E-MAIL ADDRESS: toloaldw ke re qma; t <br />%0 N.01 <br />EVENT WEB ADDRESS: <br />0 <br />PROPOSED EVENT ACTIVITIES: Av%!,,e eowyo, Ac t4 t..e.& <br />__4 p r. CA" h <br />1%9 <br />