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APrLl CATION FOR FIREWORKS PXI1MIT <br />VILLAOF. OF ONONO, MINNESOTA <br />Da to:. �.�� 19 s Application Numbers .53 <br />Name (.JR�.4T. �2nLn Tao �� ttA <br />',egress_ /S/ 134p,g7:jq Ila SS131?/ <br />Location of tIreworks Display /790uu:1.-, /'fnin"nonee 4 1 ..4�ir_— _ <br />:nme of Persons and/or Organizations Handling Fireworks Display <br />_1 FIRI.0 1 A0 t (?m Mpm)p t 1 <br />Name of any Where Fireworks will be Purchaoed <br />_ <br />147e: _� hone: Lc , c <br />fseason or Purpose <br />Type of Fireworks v// <br />.,ate of us* Q�r'��� ! /QT 19_ IT <br />Insurance Coverage <br />Amo:u:t <br />Company _ <br />Copy of Insurance Cortifiostes to be Submitted with this Application. <br />I an aware of all applicable State and other laws regarding possession and use <br />of fireworks and will abide by same. I also agree to hold the Village of Orono <br />harmloss from all liabilities that may arise directly or indirectly from the <br />shooting of fireworks approved by the granting, of thl�Dees,LL. <br />Fee: 410.00 gas ure Hof Applicant <br />DR <br />Date: , <br />Check <br />Cash�Y <br />Tni Lisle JG <br />i office Iles , , : , <br />1917 .� RECOMMENDED: Yea_ No_ <br />c ..a e y roc r <br />A' N:yV 't % Yoe IVNo <br />, 1, . rs br <br />Remarks:_._.._._____._ <br />