The person, society, club or corporation desiring a permit to hold a public dance, shall make application to the Clerk-Treasurer in the following form:
APPLICATION
The Clerk-Treasurer:
Sir:
The undersigned, on behalf of __________________ hereby makes application on _______________, 19 _, for a permit to give a public dance at No. _____________ Street. It is hereby expressly agreed that such dance shall be conducted in strict accord with the provisions of law regulating public dance and public halls and the undersigned agrees that the permit is given and accepted subject to the provisions of this application and that he shall be held responsible for any violation of any provision of laws or ordinances regulating such public dance. The owner or lessee of the premises in which such dance is to be held, is _____________, No. ________________________ Street,
Name _____________________________ Occupation ___ ________________________ Address ____________________
(Ord. 812. Passed 7-15-68.)