HomeMy WebLinkAboutEVE2022-00001 - PLN General - 9/28/2022 RECEIVED
SEP 2 6 2022
MASON COUNTY 615 W. Alder Street
400 COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
EVE 20,�, - aDOO
TEMPORARY OUTDOOR PUBLIC EVENT APPLICATION
This application must be completed,signed and forwarded to the Mason County Dept.of Community Development Office at least sixty
(60)days prior to the first day of the event. Any misrepresentation in this application or deviation from the final agreed upon route
and/or method of operation described herein, may result in the immediate revocation of the permit. Please type or print information
clearly and attach additional sheets as necessary.Once application has been submitted,the applicant will be required to schedule a
pre-application meeting with County staff to discuss event details.
EVENT INFORMATION
Date of permit: Event Name: e v
Legal Description: 00
Event Site Address:
Date(s)of Event: NOT TO EXCEED 14 DAYS: 30 -0 2-2❑ Day(s)of the Week:
Event Time: ❑ Event Start Time: ❑ Event End Time:
Event Crowd Size: articipants: 50 ❑ Spectators:( >�'/olunteers/Staff: JFC>0
-- Size of Property(if applicable):
Has this event been held previously?: Yeshe No El /�
If es, what were the dates of the event&where: I q S?� - l 9 I - YVtQ r0 .
Any change from previous events?: Yes No If yes, please attach list of changes f r this year's request.
AP LICANT INFORMATION
Name of Applicant: K c v C I v Y✓ 0d e
Mailing address:
City: State: Zip:
Home Phone: (o3 S Cell phone: '5 Email: C S
Owner's Name: s y C ju
Mailing address:
City: State: Zip:
Home Phone: Cell phone: Email:
EVENT DETAILS
Check appropriate category below and fill in details or numbers, size and type. Leave blank if not applicable.
Alcohol: Will alcohol be served or available? Will alcohol be sold?
No ❑ Yes X No ❑ Yes
Booths/Vendors: How many booth ? iv Sd How many vendors: g 7
Entertainment: Sound System: Describe: t-u-e eAt4As ONA
Acoustic ❑ Amplified lX a 5 es
Food: Will food be served or available? Will food be sold? No ❑ Yesx
No ❑ Yes X If yes, by whom?21 eM cty S
Water: Potable? No ❑ Yes Wt~y.t Non-Potable? No Yes ❑
Electricity Source: Generators? No ❑ Yes e How many? Size:
Sanitary Facilities: How many? Handicapped Accessible? No ❑ Yes
Rides: No Yes ❑ Describe:
H w many? KeA 0(i e
Land Clearing/Grading: No Yes ❑ Describe:
Fire Protection: Equipment or devices? No ❑ Yes V De cribe:
Traffic Control: Crowd control y
olicing provided? Desc e: l e�
No ❑ Yes wG Gt Vti0 -( /V Eg7C,
Ca S
Rev. August 2017
Traffic Access Plan: Road closures required? No Yes ❑ Do you have a permit? No ❑ Yes
Parking: Off Street parking available? No L Yes Scale drawing provided? No ❑ Yes
Location: Event site location 250'from schoolhouse, Describe:
church, house, residence or other human
habitation? No ❑ Yes
Public Safety Plan: Crowd Control or policing ro ided? Describe:
APPLICATION WILL NOT BE ACCEPTED WITHOUT:
1. Site Plan(5 sets): Note scale used
• Property lines,easements, &right of ways • Location of all existing structures&dimensions
• Distance, in feet,from property line&structures • Well location
• Lighting,sound plans and provision for vehicular parking • Parking areas(number&arrangement)
• Location of fire hydrants&vehicle access roads • Public Safety Plan
3. Sanitation facilities and sewage disposal plan and/or approval.
4. Security and traffic control approval by the Mason County Sheriffs Department.
5. Dept.of Health food handling permits if applicable
6. Fees will be collected at time of submittal.
REVOCATION OF PERMIT;STATEMENT OF RIGHT.
The temporary outdoor public event permit issued under the provisions of this Chapter shall state in substance that
such permit is issued as a public safety,sanitary and fire requisition measure,and that the right of the Department of
Community Development to revoke such permit is a consideration of issuance. If any Temporary Outdoor Public Event in
Mason County is not being operated in accordance with the rules and regulations prescribed in this Chapter and set
forth in the State law,the permittee shall be subject to revocation of the permit,and the permittee or other individual
responsible subject to such other punishment as the law and this Chapter provide. (Ord.No.61-09,Att.A, 7-7-2009)
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Falsification and/or misrepresentation in completing this application may result in rate adjustment or event cancellation.
I UNDERSTAND THAT CHANGES TO THE ABOVE DETAILED PROGRAM REQUIRE IMMEDIATE NOTIFICATION TO
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT.
I,the undersigned representative, have read the"Temporary Outdoor Public Event Application"and the
Policies and Procedures contained herein,and I am duly authorized by the event organization/business
to submit this application on its behalf.The information is complete and accurate.
PRINT APPLICANT'S NAME: CiU P
SIGNATURE OF APPLICANT:
SIGNATURE OF PROPERTY OWNER(IF DIFFERENT THAN APPLICANT):
DATE OF APPLICATION: FEE AMOUNT COLLECTED:
APPROVED BY DATE OF APPROVAL:
Official Use Only
Accepted b s Date Submittal Amount$ Receipt number
Department view Approved Denied Comments
Building
Environmental Health
Fire Marshal
Planning
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