Town of Springdale

TOWN OF SPRINGDALE

2379 Town Hall Road Mt. Horeb, WI 53572-2454 (608) 437-6230

This document, when signed by the Town of Springdale Board Chairman, serves as a User’s Permit for Fireworks pursuant to Code of Ordinances, Town of Springdale, WI, Sec. 7-5-1, which states that no person may possess or use fireworks without a user’s permit from the town. The town will only issue permits to residents of the Town of Springdale and/orprofessionals for hire, for the purpose of using fireworksinthe town of Springdale.

The Town of Springdale does hereby allow the party named below to possess and use *Class C and less Fireworks (2”-3” rockets) in the Town of Springdale, at the address shown below, during a private event, not open to the public, on the date(s) specified below. Fireworks must be purchased after the date of permit approval.

Please submit this application to the Town of Springdale Clerk at the address above, preferably at least one month before the event, or as soon as possible. If necessary to be on Town Board agenda, more notice will be needed.

Name of Applicant(s) ______Phone (_____) ______

Address ______

(Street) (City) (State) (Zip)

Address at which fireworks will be used if not the same as the address of the applicant:

Address ______

(Street) (City) (State) (Zip)

Exact Location of Shoot /Backyard Family Display ______

Date of Event ______Time Range of Event ______
(A Separate Permit is required for each separate date) (Begin and End Time)

Rain Date of Event ______Time Range of Event ______
(Begin and End Time)
Proof of insurance for responsible party (homeowner/sponsor/pyrotechnics company):

Insurance Co. Name/Address: ______

Effective Dates of Current Policy ______through ______

At least two days prior to the authorized permit use date, the applicant must submit a copy of this permit to the Dane Co. Sheriff’s office, and the Mt. Horeb Fire Department with a list of firework types and quantity. Fire protection (water, shovels, etc.) must be readily available during and immediately after the event. As a courtesy, please notify affected neighbors.

Liability for damages caused by a minor’s use of the fireworks: A parent or legal guardian of a minor may not allow a minor to use restricted fireworks. Store and use fireworks with safety in mind.

This permit is subject to all ordinances, rules and regulations of the Town of Springdale.

Signature of Applicant ______Date ______

Signature of Town Chairman ______Date ______

Special Conditions: ______

*Fireworks above Class C, public events, and/or by a professional company require the approval of the Town Board.