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FROM FAX NO. <br />MAR-26-06 TUR 12:01 PM CITY--iAXE«-FLMO <br />Jun. 13 2005 09:41AM P2i3 <br />FAX NO, 651 777 9615 P, 3 <br />CITY OF LAKE ELMO Pem,it No, <br />WAIVER OF WATER SURFACE USE REGULIITION3 Pate <br />Lake,S'lmv CUP Hall <br />lfodce: 6 <br />Applicant <br />l�rgaaixation _ <br />t <br />Relationship to ®rg. <br />Applicant's addressuag- <br />6 d <br />Phone N`tunbers <br />Date Preference$ <br />Hours \i! <br />A,ativity/Purposc 1 <br />: *O LaverneAve. No, <br />Lake Elmo, MN 3564; <br />r 55,10 , Fax: 651-777461$ <br />S70 <br />F, ��� <br />M <br />I have received, read, artd understand the requirements of the Lake.Rbxo ordingneg 97.13o, <br />for a Special Permit allowing the waiver for Water Ski Shows. A copy of the permit will be <br />at the event at all times dgring the permitted period of time. <br />Slohot ure of Applicant ( `9Yo 1s 0., rsm \1 n ii\ An. L1r$e <br />Approved ❑ Denied 0 Notified Sheriff El <br />City Clerk signature <br />City Administrator Signature Data <br />311(5/06 <br />