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2. Permit Date
   Permit Date
4. Event
6. I (we) hereby make application for a Sound Amplification Permit, subject to the Municipal Code of the Village of Cottage Grove.
   (If an organization, list President / Chairperson / Party / Parties responsible for application.)
8. Name of Applicant
10. Address
12. City
13. State
14. Zip Code
16. Phone
18. Name
20. Address
22. City
23. State
24. Zip Code
26. Phone
28. Other individual(s) having authority for the event:
30. Person(s) responsible for conducting the proposed use of the permit:
    (Must be 18 years of age)
32. Name
34. Address
36. City
37. State
38. Zip Code
40. Phone
42. Name
44. Address
46. City
47. State
48. Zip Code
50. Phone
52. Date and time for which the sound amplification device(s) will be used
    Date and time for which the sound amplification device(s) will be used
54. Start Time

    —

    End Time
56. Street or park at which the sound amplification device(s) will be used:
58. The proposed use, described in detail, for which the sound amplification permit is requested:
60. The proceeding information is correct to the best of my knowledge. I have received a copy of the Village of Cottage Grove Noise Ordinance (Section 219-1) and agree to abide by all the regulations and policies set forth for the use of the sound amplification permit. I acknowledge overall supervision of and responsibility for this event. By offering this permit, the Village of Cottage Grove does not accept any responsibilities, expressed or implied for any damage arising out of the use of this permit, and I acknowledge the Village of Cottage Grove has no responsibilities, expressed or implied for any damages arising out of, or connected in any way with the use of this permit.
    
    I further agree to indemnify, save, and hold harmless the Village of Cottage Grove and each and every one of its elected and appointed officials, officers, employees, agents, representatives, successors, heirs, and assigns from and against any and all claims, damages, liability, expenses, costs, judgments, actions, demands, and responsibility of whatsoever kind or nature.
62. Village of Cottage Grove Noise Ordinance
    Chapter 219 - Noise Ordinance (PDF)
64. By
    (Signature of applicant)
65. Date
    Date
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field