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shall it be liable for the death or injury of any such person occurring as a result of the use <br />of the facilities authorized hereby. <br />Signature of Applicant Date <br />Make checks payable to the City of Little Canada. <br />Date Received <br />Office Use Only <br />Application Received By <br />Charges: Rental Fee <br />Add'l Hours <br />Total <br />Approved Disapproved <br />Why Damage Deposit <br />By: Deposit Returned <br />Signature <br />Forms: Insurance Cert. <br />Title <br />Permit Number <br />Date Issued <br />Page 98 <br />