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CITY OF COLTON <br />HUMAN SERVICES DEPARTMENT <br />APPLICATION AND AGREEMENT FOR FACILITY USE <br />REQUEST FOR USE OF <br />Facil <br />(Cirde One <br />ON (DATES) <br />FACILITIES AND EOUIPMENTREOUESTED <br />We hereby certify that we shallbepersonally responsible, on <br />Multi -Use Room ❑ Banquet Tables # <br />behalf of our organization for any damage or unnecessary <br />LI Activity Room ❑ Chairs # <br />abuse of buildings, grounds or equipment through the use <br />-of said premises by our organization. <br />❑ Community Room ❑ P.A. System <br />WE AGREE TO ABIDE BY AND ENFORCE THE RULES AND <br />REGULATIONS OF THE CITY OF COLTON AND CERTIFY THAT <br />Kitchen Other <br />WE HAVE READ THE RULES AND REGULATIONS ON THE BACK <br />OF THIS APPLICATION. <br />❑ Baseball Diamond <br />Name of Organization CA�To �✓ 5 �J <br />D Pool <br />, <br />r TIME OF USE <br />FROM. QO.M <br />Name (pleas ).�t t7tSCN/P'1(0M- <br />TO <br />Sign atur <br />R K.) PA <br />Title l C, L <br />1. Purpose of Activity:Alr eFA- f- ^I <br />Address GU- 1/ul5tJ1> <br />Zip Code GwVTo-1, L 3 24L <br />�76# 0,441> <br />, <br />Phone (dayti) - ?-6 <br />2. Expected Attendance: Adults ✓r'o <br />Pate Z3 �l 3 <br />Youths; <br />3. Is Activity Open to the Public <br />YesNo <br />4. Will Adm Be Chard <br />ge <br />Yes No <br />5. Will Donations Be Accepted: <br />Yes X%No <br />If�Qat will the roceeds be used for? <br />FOR DEPARTMENT USE ONLY <br />Application For Facility Use Is: <br />Remarks <br />Approved Denied <br />By <br />Approval is Subject To Conditions Listed On Back <br />Deposit <br />Fee <br />Date Paid .19 <br />White - Office <br />Yellow -Permittee <br />Date Processed ,19 <br />Pink - FacilityGoldenrod - Public Works <br />