CITY OF MAULDIN
TEMPORARY BLOCK CLOSURE and/or AMPLIFIED NOISE APPLICATION
EVENT DESCRIPTION: ______
DATE OF EVENT ______DAY OF WEEK ______
PROPOSED START TIME ______PROPOSED FINISH TIME ______
STREET PROPOSED TO BE CLOSED AT: ______
APPLICANT ______HOME PHONE ______
HOME ADDRESS ______CITY/STATE ______ZIP ______
BUSINESS ADDRESS ______BUSINESS PHONE ______
ESTIMATED NUMBER OF PARTICIPANTS AT THE EVENT ______
WILL LIVE MUSIC OR OTHER AMPLIFIED SOUND BE PROVIDED? ___YES ___NO
IF YES, WHAT TYPE? ____ LIVE BAND ____LOUD SPEAKERS/PUBLIC ADDRESS SYSTEM OTHER (DESCRIBE) ______
NUMBER OF MEMBERS IN BAND ______INSTRUMENTS TO BE PLAYED AND AMPLICATION METHODS ______
START TIME OF MUSIC: ______FINISH TIME OF MUSIC ______
WILL BEER/WINE BE SERVED? ___YES ___NO
WILL ALCOHOL LIQUORS BE SERVED? ___YES ___NO
WILL A FEE FOR EVENT ADMISSION OR FOR BEER, WINE, OR ALCOHOL LIQUORS BE CHARGED? ___YES ___NO
IF YES, EXPLAIN______
DESCRIBE PROPOSED CROWD CONTROL METHODS: ______
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ATTACH A DESCRIPTION AND DIAGRAM OF THE STRUCTURE OR PROPERTY WHERE THE PERFORMANCE WILL OCCUR, INCLUDING DIMENSIONS, LOCATION OF ENTRANCES AND EXITS, PARKING FACILITIES, AND RESTROOM FACILITIES.
APPLICANT AGREES TO COMPLY WITH ALL OF THE TERMS, CONDITIONS, AND STIPULATIONS OF THIS PERMIT, ALL ORDINANCES OF THE CITY OF MAULDIN AND ALL OTHER APPLICABLE LAWS, AND UNDERSTAND THAT FAILURE TO COMPLY WILL RESULT IN IMMEDIATE REVOCATION OF THIS PERMIT.
APPLICANT SIGNATURE: ______DATE: ______
APPROVAL/CONDITIONS
OBTAIN BARRICADES FROM A BARRICADE COMPANY FOR ALL APPROVED STREET CLOSURES. IF EVENT OCCURS OR CONTINUES AFTER SUNSET, ALL BARRICADES MUST BE EQUIPPED WITH LIGHTS.
ADEQUATE CROWD CONTROL INCLUDING MEANS OF ENTRY AND EXIT, NOISE CONTROL, RESTROOM FACILITIES, SPACE FOR ANTICIPATED NUMBER OF PARTICIPANTS, AND PARKING ARE ALL THE RESPONSIBILITY OF THE APPLICANT.
SPECIAL TERMS/CONDITIONS/STIPULATIONS: ______
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THE ABOVE-LISTED APPLICATION IS APPROVED, SUBJECT TO ALL TERMS, CONDITIONS, AND STIPULATIONS STATED ABOVE.
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CHIEF OF POLICE SIGNATURE DATE
RETAIN THIS PERMIT AT EVENT SITE FOR INSPECTION