ࡱ> 9;8 f!bjbjqq 40eefUUUUUiiii$iCEEEEEE:EUEUUZUUCCL#i /p0UpvTNDEEE : SPECIAL EVENT PERMIT APPLICATION U.S. Army Corps of Engineers, Rock Island District Saylorville Lake In order to determine if your event will require a special event fee(s) and a special event permit from the Saylorville Lake Office, please answer the following questions: APPLICANT NAME: ___________________________________________________________________ ORGANIZATION: _____________________________________________________________________ NON-PROFIT 501 (c) (3) DESIGNATION: _______ (must provide proof with application) ADDRESS: __________________________________________________________________________ CONTACT NUMBERS: DAY______________________ EVENINGS____________________________ EMAIL:______________________________________________________________________________ FAX: _______________________________________________________________________________ ALTERNATE CONTACT PERSON: _______________________________________________________ ALTERNATE CONTACT NUMBER: DAY__________________ EVENINGS______________________ PROPOSE ACTIVITY (include a brief description of event, date, time and specific location): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ EXPECTED NUMBER OF PARTICIPANTS: ______ VEHICLES: _______ VESSELS:_______ IS THE EVENT OPEN TO THE GENERAL PUBLIC?:_______ ORGANIZATION/CLUB MEMBERS ONLY? ______ ARE FEES OR ENTRANCE DONATIONS OF ANY TYPE TO BE COLLECTED FROM THE PUBLIC OR PARTICIPANTS? ______ IF YES, WHAT ARE THE AMOUNTS AND FOR WHAT PURPOSE WILL THEY BE ASSESSED? WHAT ARE EXPECTED GROSS REVENUES? FOR WHAT PURPOSE WILL COLLECTED FUNDS BE USED? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ WILL THE EVENT INVOLVE VENDORS? _____ IF YES, LIST EACH INDIVIDUALLY. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ HOW WILL ACCESS TO AND FROM THE EVENT AREA BE CONTROLLED AND NON-PARTICIPATING VEHICLE AND BOAT TRAFFIC BE DIRECTED AROUND OR THROUGH THE EVENT AREA? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ARE EXISTING SANITARY FACILITIES ADEQUATE TO ACCOMMODATE EXPECTED CROWDS?________ IF NO, WHAT MEASURES WILL YOU TAKE TO PROVIDE NECESSARY FACILITIES? ________________________________________________________________________________________________________________________________________________________________________ WILL FIRST-AID, FIRE AND RESCUE SERVICES AND OTHER SAFETY MEASURES BE NEEDED? _______ IF YES, WHAT ARRANGEMENTS AND WITH WHOM WILL BE MADE TO PROVIDE THESE SERVICES? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ WILL BUOYS, TEMPORARY COURSE MARKERS OR LAKE TRAFFIC CONTROL MEASURES BE REQUIRED? _______ IF YES, PLEASE LIST REQUIREMENTS AND SPECIFIC LOCATIONS. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ARE ADDITIONAL PERMITS FROM OTHER GOVERNMENT AGENCIES REQUIRED? _____________ IF YES, PLEASE LIST AGENCIES AND TYPE OF PERMITS. ________________________________________________________________________________________________________________________________________________________________________ WILL ADDITIONAL SECURITY MEASURES BE REQUIRED FOR CROWD OR TRAFFIC CONTROL? __________ IF YES, PLEASE PROVIDE MEASURES THAT WILL BE TAKEN AND ANY LAW ENFORCEMENT AGENCY THAT WILL BE ASSISTING IN PROVIDING ADEQUEATE PUBLIC SAFETY. ________________________________________________________________________________________________________________________________________________________________________ DO YOU HAVE ANY SPECIAL REQUESTS OR CIRCUMSTANCES? _____ IF YES, PLEASE PROVIDE. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The Privacy Act of 1974 requires that each individual asked or required to furnish personal information be advised of the following: Authority: 5 P.L. 93-579 Purpose: To provide a contact in connection with permit activities Routine Uses: Permit is issued under the direction of the Rock Island District Corps of Engineers. The names and addresses of those who obtain the permit are not reported, but are kept on file at the project office to provide a point of contact in case of emergency. This information is not maintained alphabetically or by other personal identifier. Disclosure of information is voluntary. Failure to provide the requested information will preclude issuance of permit. Please return the completed special event permit application to our office by one of three ways (do not send any payments at this time): Mail: Fax: Email: US Army Corps of Engineers 515-276-2088 Saylorvillelake@usace.army.mil Saylorville Lake 5600 NW 78th Ave Johnston IA 50131 Fee Schedule: Basic special event permit fee (non-refundable): $50.00* Ranger Staff $40.00/hour Boat/w Crew $125.00/hour Additional Picnic Tables $20.00 ea Additional Garbage Cans $10.00 ea Additional Mowing $50.00/acre * Basic fee can be waived under limited circumstances !efg  ` g   ] d  / b    ` 2;<BCD_~úñèúúúúúúúúÜÓÓÓúèèÓÓÓhJzT6CJ]hN56CJ\]h16CJ]h[1e6CJ]h~66CJ]hN6CJ] hN6]hv5OJQJ\^JhN5OJQJ\^JhNhN5CJ OJQJ\^J:!Tefg  h i   e f  c d   c  gd3$a$ TUrs W56l M&r #\qMV&4k\kl&ʻzh 96CJ]aJhJzThJzT6CJ]aJhJzT6CJ]aJ hJzThJzT56>*CJ]aJhc56CJ]aJhJzThJzT56CJ]aJhN6CJ]h+X6CJ]hc6CJ]h~66CJ]hJzT6CJ]hN6CJ]0& " 3 E U !0!f!gd5]&gd5]&gdJzT , . 3 < E T U ܱn]On;n]On&hch5]&5CJOJQJ\^JaJhcCJOJQJ^JaJ hch$CJOJQJ^JaJ hch5]&CJOJQJ^JaJh$6CJ]aJh+X6CJ]aJh5]&6CJ]aJ hch$56>*CJ]aJ hch5]&56>*CJ]aJhR 6CJ]aJhJzThJzT6CJH*]aJhJzThJzT6CJ]aJh6CJ]aJhJzT6CJ]aJ !!!/!0!2!e!f!ĸ h.E6]h+X6CJ]aJ h+X6]hch5]&6CJ]aJhch5]&6CJaJhch$6CJaJhcCJOJQJ^JaJ hch5]&CJOJQJ^JaJ hch$CJOJQJ^JaJ 21h:p~6/ =!"#$% ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH L@L  Heading 3$$@&a$5OJQJ\^JDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List DP@D Body Text 26OJQJ]^JPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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