OUT-OF-DOORS AND OPEN-AIR

PUBLIC ASSEMBLY PERMIT

DATE RECD._______________
APPLICATION NO.
I,

_______

_______________

on behalf of

application to hold a public assembly at

Ohio, for the purpose of a

___________________

________________________________ Fairfield,

__________________

Attached details/set-up/lay-out required:

Start time:
End time:

herewith submit my

on

_________________________.

_______________________________________
Name
_______________

______

_
Fairfield, OH
City and State

45014________________

(513) ___________
Telephone No.

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==
(FOR CITY USE ONLY)
Building/Land Owner
Address
ELECTRICAL INSPECTION:
Condition of Building/Land
Inspected by__________________________________________________
Date
FIRE INSPECTION:
Condition of Building/Land
Inspected by__________________________________________________
Date
SAFETY INSPECTION (Police Department):
Condition of Building/Land
Inspected by__________________________________________________
Date

==========================================================================================
Permit No.
Approved by

issued on

.
, City Manager