APPLICATION FOR SOUND AMPLIFIER PERMIT

Event: ________________________________________________

Date and Time of event:__________________________________

Name and Address of

Applicant:______________________________________________

______________________________________________

______________________________________________

Name of owner of device:_________________________________

Location of event: _______________________________________

This permit is being issued in reference to the City of Russellville ordinance referring to the use or operation of all sound amplification devices within the city limits of Russellville.

Amount Paid _______________ □ check □ cash