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Washington 1615 Keats Ave N <br />Special Use Permit Request <br />.� COL my Lake Elmo, MN 66042 <br />Pine Point Raglonal Park <br />Policy M PKP005 <br />Parks Division (661) 430.8370 <br />❑ <br />Pt, Douglas Park <br />Group/Agency: M8800loty <br />Data of Event: <br />0 611 212 01 6 <br />Contact Name: ScottAhigren <br />Setup Time: <br />8:00 NAM ❑PM <br />Address: 200 92in Ave. S. <br />Start Time: <br />8:00 ®AM ❑PM <br />City, State, Zip: Minneapolis MN 56415 <br />Est. Attendance: <br />400D <br />E -malt: ecottahlgran@nmse,org <br />Phone: <br />763-228-M0 <br />Park Location: <br />❑ <br />Sig Marine Park Reserve <br />❑ <br />Pine Point Raglonal Park <br />❑ <br />Cottage Grove Ravine Regional Park <br />❑ <br />Pt, Douglas Park <br />ED <br />Hardwood Crook Trail <br />❑ <br />Square lake Regional Park <br />❑ <br />Historic Courthouse <br />❑ <br />St, Croix Bluffs Regional park <br />❑ <br />Lake Elmo Park Reserve <br />Describe locattonffacilltles within Park you are requesting, Include a ma of proposed route if necossa : <br />Use of the Hardwood Creek Trail for the Ms 160 Bike Tour. Riders will be on the Hardwood Creek Trail portion an <br />the route from 10:00 am to 3:00 pm travglfng south. We have rest stops set up in Wyoming and Hugo. <br />Where �n Wi a <br />Type of Event: (select all that apply) <br />Single Day Event (Fun Run, Duathlons, Trlathlons)* <br />❑ Up to 100 people <br />100 to 300 people <br />300 to boo people <br />Over 600 people 001 - <br />Lesson package (recurring dates, up to 16) <br />Still Photography <br />Video Photography <br />Unusual Video Photography <br />Pee: <br />Vehicle Permits - Required for alf <br />$100 <br />vehlcles entering the park (Including drop - <br />$300 <br />offs). $6/day or $26 annual <br />$600 <br />❑ Purchased by event entrants <br />-Gensulb <br />❑ Purchased by event organizer <br />$200 <br />❑ Volunteers will hand out at gate <br />$160 <br />$200 <br />NOM, Mae& dropping oflentrants must also <br />Consult <br />hhve a vehicle permit, but may Dome and go as <br />many times as needed <br />* If the event leaves the park, contact the Office specialist, Washington County Milo Works, at 661-430.4313 for a road <br />permit, Any event that takes place In a body of water will require an adequate number of certified lifeguards, <br />Direct Costs: <br />Any costs not covered by the Special Use Fee, including extra hours of park staff time, vohicle permits, <br />dumpsters, portable toilets, (Groups over r000mmendod 000upanoymay require speelal faolllfies such as <br />portable toilets or dumpsters. DallvoWlsetup of the extra facilities will be arranged by park office and added to <br />the Special Use fee as a Direot Cost) <br />Insurance: <br />Certificate of insurance must be on file at feast 2 weeks before event, <br />i understand there may be special fees and Insurance requirod. I understand that the checklist will be reviewed <br />bythe parks Supervisor or doslg pee. Ihavo road the Speclai Use Policy for Washington County parks. l agree to <br />follow the guldeilnes and park pfftanoo #f74, 1 understand ourgroup will be denied the commercial use if the <br />policy is not followed. / <br />Slgnature/TlNeofAuthorized Person Date <br />---- ----....w_..........-------._....-.---•-----._._.. ....... --------- -- ..._._..... <br />offmo use only <br />Usepermit#,lea Uae Agreement_,Incumnoe aedt8cata: Pgymani: <br />Implemented.11101 Revised 1114,2/q6, 12116 <br />