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OC -L-14-98 04:13P DURON BJSINESS FORMS 1714} 876.5140 CITY OF COLTON HUMAN SERVICES DEPARTMENT APPLICATION AND AGREEMENT FOR FACILITY USE P.01 REQUEST FOR USE OF FLEMM PARK .} C3 Facility/Pod/RG a/Park (Circle One) ON (DATES) __ Saturday, December 12 FACILITIES AND EQUIPMENT REQUESTED :1 Multi -Use Room C3 Banquet Tables # ❑ Activity Room ❑ Chairs D Community Room U P.A. System ❑ Kitchen O Other ❑ Baseball Diamond 0 Pool TIME OF USE FROM 9:30 TO 12: 00 ��--�� `,p,AA!P.M. AM -a 1. Purpose of Activity: Parade awards & give Anr3 Santa sways 2. Expected Attardance: Adults 300 Ido La Cadena Dr, Youths 300 3. is Activity Open to the Public: Phone (daytime) Yes vY No Date Oct 4. Will Admission Be Charged: Yes No xx 5, Will Donations Be Accepted: Yes No xx If yes, what will the proceeds be used for? Application For Facility Use Is: Approved ✓ Denied We hereby certify that we shall be personally responsible, or, behalf of our organization for any damage or unnecessary abuse of buildings: grounds or equipment through the use of said premises by our organization, WE AGREE TO ABIDE BY AND ENFORCE THE RULES AND REGULATIONS OF THE CITY OF COLTON AND CERTIFY THAT WE HAVE READ THE RULES AND REGULATIONS ON THE BACK OF THIS APPLICATION. Name of Organization Colton Chamber of Commerce Name (please print) Pam Gregory Signature Title ,. Ad„ Assitant 620 Ido La Cadena Dr, Address Gty, Ztp Code Col ton Phone (daytime) 525-2222 Date Oct � 5 A1998 19 FOR DEPARTMENT USE ONLY By �,tr Approval Is Subject To Conditions Listed On Back Deposit Fee White • Ottite Yellow • Permittee Pink - Facility Ga!denrod - Public Works Remarks Date Paid Date Processed ,19 ,19