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APPLICATIO14 FOR DANCE PEI ZAI <br />City of Colton . . <br />ORGANIZATION REQUESTIN"33 DANCE PERIAIT,5ocLedGz�,/ <br />INDIVIDUAL REQUESTIi�'G DANCE PERMIT <br />DATE OF DANCE / TIME: From, Yoy To /,-, r./�� <br />PERSON IN CHARGE <br />P <br />ADDRESS % (� ���� % . �� eY-�-z'' PHONE_C G� <br />LOCATION OF DANCE r `" 2� // ,S � M-�-e tta <br />IF YOUTH DANCE, HOW MANY ADULTS WILL SUPERVISE fL� <br />ADMISSION' CHARGE: (If Any) <br />Per Person Per Couple <br />APPROXI, ATE NUMBER OF PERSONS TO ATTEND—' <br />WILL ALCOHOL BE SERVED? <br />SIGNfATURE OF APPLICANT:y mac- ter —�7 <br />ADDRESS—/--__6ZY i, /�� �- L< , PF?ONE �� S- & / , <br />------------------------------------------ ------------------------------------ <br />APPROVED BY COUNCIL ON MOTION -OF SECONDED <br />.BY AND CARRIED, SUBJECT TO RATIFICATION OF THE <br />CHIEF OF POLICE. <br />APPROVED: <br />--Z--�: <br />REMARKS: <br />Rr <br />• <br />