CHRISTIAN COUNTY EMERGENCY MANAGEMENT



CHRISTIAN COUNTY EMERGENCY MANAGEMENT

100 W. Church Room 100 Ozark, MO 65721

(417) 582-5400 Fax (417)581-2368

SPECIAL EVENT PERMIT APPLICATION

APPLICANT INFOMATION Date Submitted________________________

Name:________________________________________ E-mail:______________________________________

Company/Organization: ______________________________________________________________________

Address: __________________________________________________________________________________

City/State/Zip:______________________________________________________________________________

APPLICANT PHONE NUMBERS

Daytime: ____________________________________ Evening: _____________________________________

Cell: ________________________________________ Fax: _________________________________________

Phone that you can be reached at during the event: _________________________________________________

EVENT ORGANIZER (circle one) Same as above Professional/Hired Organizer Other

Name:_______________________________________ E-mail:_______________________________________

Company/Organization: ______________________________________________________________________

Address: __________________________________________________________________________________

City/State/Zip:______________________________________________________________________________

EVENT ORGANIZER PHONE NUMBERS

Daytime: _____________________________________ Evening: ____________________________________

Cell: _________________________________________ Fax: _______________________________________

Phone that you can be reached at during the event: _________________________________________________

Set-up Date(s): ___________________________________ Time: ____________________________________

Event Date(s): ____________________________________ Time: ____________________________________

Clean-up Dates(s): ________________________________ Time: ____________________________________

EVENT INFORMATION

Title of Event: ______________________________________________________________________________________

Purpose of the Event: ________________________________________________________________________________

General Description of Event: _________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Is this a Benefit? Yes No Name of beneficiary?__________________________________________% donated_______

Event Location: ____________________________________________________________________________________

Is property within City Limits? Yes No Which City?_______________________

How is the property zoned? (commercial, Residential, etc.) ____________________________________________________

Property Owner: ______________________________________ Do you have a contract with them? _________________

Property Owners Phone: Home__________________ Work___________________ Cell_________________________

Expected Attendance (including event crew, participants and spectators): _______________________________________

Ticket Sales: (circle all that apply) Phone ~ Internet ~ thru Businesses/Organizations ~ At the gate

Outside source (example: TicketMaster)________________________ ~ Other____________________________

Is ticket sales intended for: (circle all that apply) Local Regional Midwest National International

Intended Audience: (circle all that apply) Kids Teenagers Young Adults Adults Senior Citizens

Specialized Audience: (explain) __________________________________________________________________________

Hours of Event (explain in detail):_______________________________________________________________________

__________________________________________________________________________________________________

Is this an Outdoor Event? Yes No Will there be music: Yes No Type of Music: _________________________

Will there be Camping on site? Yes No

Will there be Security? Yes No Type of Security: Professional Company ~ Off-Duty Law Enforcement

Name of Security Agency__________________________________ Armed? Yes No Licensed? Yes No

Will entrance and exits be monitored by security? Yes No

Will there be Alcohol served onsite? Yes No Will Alcohol be permitted to be brought in to the event? Yes No

Will there be food sales? Yes No Will food be permitted to be brought in? Yes No

Is the Event Organizer and/or Applicant insured for this type of event? Yes No

What is your plan for sanitation/waste water: □ Porta-Potties □ Onsite Facilities

Event Specifics: (circle all that apply) pyrotechnics ~ lasers ~ Bon-Fire ~ Aircraft

Other____________________________________________________________________________________________

Will a stage be built? Yes No Will Medical Personnel be on site? Yes No

Does the organization that holds the event hold a current 501(C)3 not-for-profit registration? Yes No

Has this event taken place previously? Yes _____ No _____

If yes: When: ____________________________________________________

Where: _______________________________________________ Attendance: ____________________________

Do not write below this line

Approved Not Approved

___________________________________

Signature

Zoned accordingly? Yes No P&D Approval? Yes No

|Sheriff Yes No |Local Law Enforcement Yes No |EMA Yes No |

|Local Fire Dept Yes No |Health Dept Yes No |Highway Patrol Yes No |

|EMS Yes No |Planning Dept Yes No |County Commission Yes No |

Special Requirements:

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