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Pending Certificate of Insurance and Part 18
VILLAGE OF EAST AURORA
APPLICATION FOR TEMPORARY USE PERMIT
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Not less than 60 days or more than 75 days before date of activity
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$25.00 Application Fee / $50.00 Permit Fee . //
$100.00 Maller Fee (300 feet for road/public parking lot
Date Application Flied: , ,).,/I 7 /2 (r,
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Approved,___ Disapproved,. ___
DateofV.B.Action: ;/ )/ ·y(r
t I Conditions of approval wHI lJo listed In the permit,
Sect, 285-52 Participants ofan area activity, such as, but not necessarfly limited to, a sidewalk sale, art, antique, craft
Pleasetype6rprlnt ieiibly
show and/or sales, farmers market, or community/civic promotion activities and slmllar,
Name of Organization: 'f'hQ, 11 uv:t ,J 11'\v'>1'c fq,-\-; vJ\
Is Organization a: p
Cnot--for- rofli) Charlt�ble service Business School
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Governtnent
Name & Address __:o,d,cQJ.��:rs..1c,__�'.1!\.,1.&cC..,_---=:14L-.2.:>!.lllt,,,..J.:s.lL._i.,cil
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Phone Numb
Event Name: _\_i:,l..�)&!W,__(:i.-'i--_.l.'_),\/_:,0_-',,__L"-.l_li_'-"--"'�---------------�---
Date(s) of Event: \�\17)\ 2. \0 \4
Time(s) of Event: 2)- \ '.l. \Y\ Estimated II of People: 8
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Please describe activity/purpose of this event: '.fv ,,� '"'''s'Lv �o ✓ L<i ,,;(d Ckvl(','t,12 s '€ 1ivS' •�sSt.5
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Locatlon{lncludeallareasoftheevent}: \}; q,_()\ll, v.iJ1., - Seu Aav.9.L..._J rY\6)I 9'1,
) (attach map)
WIii this event be donating a portion of proceeds to one or more charities and publicizing that In promotional
material?@ No
If yes, list charities and the percentage of proceeds to be donated: ___,,,lj'-'_(:)=--·-7
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WIII this event be held entirely In the Village of East Aurora?® No
If no, specify: ________________________,___
WIil the event include more than one vendor/organlzatloniCYes)No (if Yes, attach 11st ofvendors/paftlcipants)
WIii the event involve a street or parking lot clf>SLire/usag�No if yes, please note: /
Road/Lot Name(s}: S1c<c, A:t\0-<\-\,vc.,J !
Date(s} of Closure: lj \ \2 \ '2 (o Tlme(s): '.\{?Mffi 1,
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Will the event include: r
Parade or motorcade Yes (if Yes, attach Map of route) /
Walk or Run Yes (If Yes, attach Map of route}
Will there be outdoor musi� No Time & Location: _______________
Amplification: (Jif;::, @ No Type: (® DJ Multiple/Mixed
Will you be providing or selling alcohol? ;
Will people be allowed to bring alcohol? Yes � yes 1n o.rec---- bu-I- /\)o r1 ve11 uP)
Will there be Security Guards? Yes �='-"--'-=e>'�Y
Please List Entity Name,_____'.:,Ece><�&J��__i._:___�c,11,..��='=--------------
Will there be temporary food stand� N?
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Vu"d G✓ i,,; \ \-
How many? ,r,,t:, i;::',<>;l'Y" A\\<;,,1..1v>1 /
Food Truck? If yes, name of vendor: A\\ 1/..,1,� "v <, 1oi, / I btd\, Ptr ro,
{additional permit required}
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Will a tent or other structure be erected for the event? Yes@ Size: _____________
Date & Time to be installed ___________Date & Time to be removed _________