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2. 
3. PUBLICE ENTERTAINMENT LICENSE APPLICATION

5. Provided for in Section 5.48.060 of Code of General Ordinances of the CITY OF WHITEWATER

   
   

7. First Name*
8. Last Name*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Telephone*
17. Email
19. Date of Birth*
20. Place of Birth*
22. Driver's License #*
23. State*
25. Location of Entertainment*
27. Dates/Times for Entertainment*
29. Type of Entertainment*
31. Signature*
32. Date*
36. Received By
37. Date
38. Date to PD

42. INSPECTION

    Inspection of the premises will be made by the Chief of Police and Building Inspector prior to the commencement of the event, in order to determine that the conduct of the entertainment shall be safe, wholesome, and in accordance with the Code of Ordinances of the City of Whitewater.

44. Police Approved
45. Denied
46. Date
48. Inspector
49. Date
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field