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NOTICE Name of Applicant: John Elliott, Warsaw Community Development Corp. Address: 120 S. Lake Street, Warsaw, IN 46580 Telephone: 574-268-1207 Request permission to conduct the following event on the public water/frozen surface of public waters of the State of Indiana. Fireworks Display The event will be held on July 3, 2010 at 5 pm - 11 pm on the waters of Winona Lake at Warsaw. The course over which the requested event will be conducted is approximately two barges anchored in middle of lake and located in the vicinity of Kosciusko County Fairgrounds. Alternate dates(s) in case primary dates are in conflict with other events or inclement weather. 1. The applicant shall attach, on the reverse side of this application, a detailed sketch of the area over which the proposed event will be conducted. This sketch shall provide a description of the course. The sketch should include the location in respect to swimming beaches, docks, piers, or other structures used by the general public. 2. The applicant shall attach on the reverse side of this application, proof of publication for the public notice to 312 IAC 6-3-3. 3. If waiver of the life preserver requirement for the event is necessary the applicant shall comply with the provisions of IAC 14-15-2-6(c). enclose the stipulated documentation together with this application. m6
