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2. Please be advised that the noise permit will not extend beyond 11:00 p.m.
4. Event Sponsor
   Please fill out this section of the form with details pertaining to the person responsible for event and noise if complaints are received.
6. Your Name (Not the Agency's Name)*
7. Date of Birth*
   Date of Birth
9. Email Address*
10. Phone Number*
12. Physical Address
14. Town
15. State
16. Zip Code
18. Mailing Address
20. Town
21. State
22. Zip Code
24. Event Information
    Please fill out this section of the form with details pertaining to the event.
26. Location of Event
28. Physical Address of Event
30. Date(s) of Event
    Date(s) of Event Start Date

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    Date(s) of Event End Date
32. Requested Starting Time of Event
    Requested Starting Time of Event
33. Requested Ending time of Event
    Requested Ending time of Event
35. Type of Event
    e.g., Baptism, Birthday Party, Wedding, Concert, Employee Party, etc.
37. Please explain the type of noise expected. Live music, band, D.J., acoustic, amplified music, sound system of any type, dancing, etc.
39. Type of Noise
    e.g., Band, DJ, Acoustic, Amplified Music, etc.
41. Band Name
43. First & Last Name of Person Providing Music
45. Phone Number of Music Provider
46. Email Address of Music Provider
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field