Laserfiche WebLink
/�/ 8� <br /> � �O \\ ��. //�� _ <br /> � �'� ���� Bi Island Nature Park �����e�`"'�� <br /> � ��^} �J� g <br /> ��� �� '".'�.��� Special Activity Permit Application <br /> `�xEsxo� <br /> City of Orono ❑ Fee: $ <br /> 2750 Kelley Parkway ❑ Late Fee: $ <br /> P.O. Box 66 <br /> Crystal Bay, MN 55323 Date Received: <br /> Type of Activity(check all that apply) <br /> ❑ Activity that involves more than 25 persons visiting the Park at one time <br /> ❑ Activity that requires 5 or more boats to be docked at the Park at one time <br /> ❑ Activity that requires the use of temporary shelters, tents,tarps, canopies or the like <br /> ❑ Research activity involving potential disturbance of cultural resources <br /> ❑ Disposal of Cremation remains <br /> ❑ Other(describe) <br /> Applicant Information <br /> Name• <br /> Address: <br /> City, State, Zip: <br /> Phone: <br /> Email: <br /> Organization (if applicable): <br /> Address: <br /> City, State, Zip: <br /> Phone: <br /> Activity Details <br /> Name of Activity: <br /> Location(s)within Park: <br /> Date(s): <br /> Hours: <br /> Applicant Phone#on Activity Day: <br /> Description of Activity: <br /> (use additional paper if necessary) <br /> I am aware of all applicable State laws ancl City Ordinances regarding special activities on Big lsland and wiU abide by sam� <br /> IN CONSIDERATION of being a[lowed lo corizmence and operate the above-described activity,the undersigned hereby releases, <br /> waives,discharges,and covenants not to sue tlie Ciry of Orono,the City's elected offrcials,employees, volunteers,or agents <br /> ("Releasees")for injuries,death,or damages caused by the negligence of Re[easees as a result ojparticipaling in the above- <br /> described activiry. The undersigned further agrees to protect,indemnify,and hold harmless Releasees from any and all damages, <br /> [iability,and costs,including attorney's fees,for injuries,death,or damages caused by the neg[igence of Releasees. This Llelease and <br /> Indemnifieation does not app[y to intentional,willful,or wanton acts by Releasees. <br /> The applicant for a Big Island Nature Park Special Activity Permit shal/pay a service charge for the governmenta!services provided <br /> to enforce the Orono Cit��Code related to such activity;nnd the City may,as a condition of approval of the permit,reyuire that the <br /> applicant deposit money with tlze City in a sum equal to the estimated service charge to be incuned by the City. Service charges <br /> include al!City staff time or City consultant time neeessary. <br /> Signature Date <br />