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LG214 <br />(729/91) <br />Minnesota Lawful Gambling <br />Premises Permit Application - Part 1 of 2 <br />p of'Applicatio . <br />Renewal <br />Organization base license number <br />Premises permit number <br />I xx New <br />argarlxzatipn. Zriform'atic <br />FOR BOARD USE ONLY <br />BASE # <br />PP # <br />FEE <br />CHECK <br />INITIALS <br />DATE <br />Class of premises permit <br />(check one) <br />❑ A ($400) Pull -tabs, tipboards, paddlewheels, raffles, bingo <br />a BMW) Pull -tabs, tipboards, paddlewheels, raffles <br />❑ C ($200) Bingo only <br />❑ D ($150) Raffles only <br />Name of Organization <br />Little Canada Volunteer Fire Dept. <br />Business Address of Organization - Street or P. 0 Box (Do not use the address of your gambling manager) <br />325 East Little Canada Road <br />City State Zip Code County Daytime phone number <br />Little Canada, MN 55117 Ramaay (61g 484 -2722 <br />Name of chief executive officer (cannot be your gambling manager) Tide Daytime phone number <br />Richard E. Boss, III Fire Chief 612)484 -7375 <br />Bingo Occasions <br />If applying for a class A or C permit, fill in days and beginning & ending hours of bingo occasions: <br />No more than seven bingo occasions may be conducted by your organization per week. <br />Day Beginning /Ending Hours Day BegLutfng/Ending Hours Day Beginning /Ending Hours <br />to <br />to <br />to <br />to <br />to <br />If bingo will not be conducted, check here <br />to <br />to <br />G aambling Premises Xnfaz mgioia„ / s <br />Name of establishment where gambling will be conducted Street Address (do not use a post office box number) <br />Saxon Lanes and Lounge 61 West Little Canada Rd. Little Canada, MN 5511' <br />Is the premises located within city limits? I$i Yes O No If no, is township Ej organized c unorganized O unincorporated <br />City and County where gambling premises is located OR Township and County where gambling premises is located if outside of city limits <br />Little Canada, Ramsey <br />Name and address of legal owner of premises City State <br />Kraus - Anderson Bowl 2510 Minnehaha Ave. Mpls., MN <br />Does your organization own a •ui .ing where a gambling will be conducted? Ic YES 12t1 NO <br />If no, attach the following: <br />• a copy of the lease (form LG202) with terms for at least one year. <br />• a copy of a sketch of the floor plan with dimensions, showing what portion is being leased. <br />A lease and sketch are not required for Class D applications. <br />Zip Code <br />55404 <br />Address of storag:Y.:». .... , . .;. `o£gaz 'tiling equipment Dolortteeapoboxrtumber' :) <br />Address City State Zip code <br />325 E. Little Canada Rd. Little Canada, MN 55117 <br />2504 N. Rice St. Little fanaAa MN R114 <br />61 West Little Canada Rd. Little Canada, MN 55117 <br />Page 4 <br />