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Home My WebLink AboutSpecial Event Application 7.12.22_hw editsDeputy Clerk of the Board Adiel McKnight Phone: 360-385-9102 1820 Jefferson Street Fax: 360-385-9382 P.O. Box 1220 Email: afmcknight@co.jefferson.wa.us Port Townsend, WA 98368 Jefferson County Special Event Application This application must be completed, signed, and forwarded to the Jefferson County Administrator at least ninety (90) days prior to the first day of the event. Any misrepresentation in this application, or deviation from the final agreed upon route and/or method of operation described herein, may result in the immediate revocation of the permit. Please type or print information clearly and attach additional sheets as necessary. 1. Event Event Name: __________________________________________________________________________ Event Type: Exhibition (EX) ____ Race (RA) _____ Ride (RI) _____ Musical Event (ME) ______ (check one) Parade (PA) _____ Walk (WA) _____ Festival (FE) _____ Run (RU) ______ Dance (DA) _____ Drama (DR) _____ Other (OT): Specify___________________________ Event date(s) _______________ Day(s) of the Week _____________________ Time(s) OPEN and CLOSE each day________________________________________________ Event Location ________________________________________________________________________ Facilities to be used (check): Park ______ Street _______ Sidewalk _______ Private Property _________ Set up times: Begin: _____________________am/pm Dismantle: _________________________ am/pm Purpose of Event: ______________________________________________________________________ Event Crowd Size: Participants __________ Spectators __________Volunteers/Personnel ____________ Has this event been produced previously? Yes ___ No ___ If yes, what were the dates _______________ Any change from previous events? Yes ___ No ___ If yes, list changes for this year’s request: ___________________________________________________ 2. Applicant Information Organization Name:____________________________________________________________________ Mailing Address and Zip Code:___________________________________________________________ Applicant’s Name ____________________________________Title _____________________________ Phones #(s): Home: ________________________ Work: ______________________________________ Cellular: _____________________ Email: _________________________________________________ Contact Person: _______________________________________________________________________ Phones #(s): Home: ____________________________ Work: __________________________________ Cellular: __________________ Email: _____________________________________________________ Event Name: __________________________________________________________________________ 3. Exemption Request Are you requesting exemption from the special event fees? Yes _____ No _____ State the reason for the exemption (e.g. constitutionally protected, etc.) ___________________________ 4. Fees and Proceeds Admission Fee: (Check one) Yes _____ No _____ If yes, how much? ____________________________ Any vending or sales: Yes _____ No _____ If yes, check all that apply: Books _______ Balloons ___________ Other: Specify ______________________________ Beverage _____ T-shirts/Hats ________ Buttons ________ 5. Food Food Yes__ No ___ Food Vendors Yes___ No___ Food Provided at no cost Yes ____ No_____ ** If yes please list foods and food vendors _______________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________ Mobile food vendors may operate at the event with a valid annual mobile food service permit from Jefferson County Public Health (JCPH). Caterers permitted by JCPH who operate at the event must contract with a client to prepare a specific menu and amount of food in a licensed commercial kitchen for service to the client's guests or customers at the event location. Other food vendors must obtain a temporary food service permit by submitting application to Jefferson County Public Health at least 10 days prior to the event. Applications submitted late are subject to a 50% late fee. Vendors who qualify for a TFS permit exemption (see page 3 of application at https://www.jeffersoncountypublichealth.org/DocumentCenter/View/3932/Temporary-Food-Service-Application?bidId) must still apply for the permit exemption. All food vendors must have their permit from JCPH. Each food vendor/booth must be equipped with a temporary hand wash station meeting the requirements of the State Food Code WAC246-215 and meet all TFS rules and regulations (see https://www.jefferson countypublichealth.org/DocumentCenter/View/9658/Guidance-for-Temporary-Food-Service). All food handlers must read and sign the TFS rules and regulations, which must be posted in the booth next to the valid TFS permit issued by JCPH. 6. Entertainment and Promotions Sound System: Acoustic ____________ Amplified ___________ Describe entertainment: _____________________________________________________________________________________ _____________________________________________________________________________________ List of entertainers or bands performing at event: _____________________________________________________________________________________ _____________________________________________________________________________________ Check type of promotion you plan to use to attract participants: TV _________ Radio _________ Newspaper _________ Billboards ___________ Posters ___________ Flyers _______ Other: Specify ___________________________________________________________ Have local neighborhood groups or businesses approved your event concept? Yes ________ No _______ If no, what steps will be taken to notify them of your event ____________________________________________________________________________________ List community contacts and phone numbers (for verification) or attach an approval letter: Name: _______________________________________________Phone # _________________________ Name: _______________________________________________Phone # _________________________ 7. Special Set-Ups Requested Check appropriate category below and fill in details on numbers, size and type. Leave blank if not applicable. a. Animals ____________ How many __________ Species ____________________________________ b. Booths _____________ How many __________ Where _____________________________________ c. Commercial Signs _____ How many __________Size ______________________________________ d. Electricity Source _____ Generators __________ How many _________________________________ e. Fireworks _________ Ground ______ Aerial _______ Fireworks Company ______________________ f. Portable Restrooms _____ How many ____________ Handicapped accessible ____________________ Provider: ____________________________ PORTABLE TOILETS/WASTEWATER MANAGEMENT Portable toilets shall be provided in the stage and vendor area. 1 toilet to 150 people If the event is serving alcohol or is alcohol related – beer fest, wine fest then additional toilet facilities may be warranted - If alcohol is served at the event one portable toilet shall be required per 75 participants. One portable toilet must be ADA compliant A combination of portable toilets and permanent facilities can be used. Approval for use from the permanent facilities owner must be provided to Jefferson County Public Health (JCPH). Permanent facilities must be current with their O&M inspection frequency and have no deficiencies. Portable toilets shall be provided within 200 feet of all camping sites. Multi-day events must provide a station with potable hot and cold water, and wastewater containment for campers. A combination of portable toilets and permanent facilities can be used. Written approval for use from the facilities owner must be provided to JCPH. Facilities on an onsite sewage system must be current on O&M inspections with no deficiencies. Verify with JCPH onsite sewage staff for capacity of the septic system. Mobile food units must submit a waste water disposal approval letter to the OSS Sanitarian at JCPH in order to operate at the event. g. Hand Washing Station Yes __________ No ____________ if Yes How many____________________ Provider (if different than restroom): ____________________________ A minimum of 1 hand-washing station shall be provided in the vicinity of food vendors for every 150 participants/attendees. One hand washing station must be ADA compliant. A minimum of 1 hand-washing station shall be provided within 100’ of food vendors. h. Water _______ Potable ____________ Non –Potable _______________________________________ Source:____________________________ WATER If the water source onsite that serves the event site is not an approved public water supply and cannot be used as a source of potable water for the event, requirements for use of a storage tank (importing water to the event) are as follows: Provide Jefferson County Public Health (JCPH) with a written plan to manage the stored water supply, including: water source, transport, volumes, treatment and method of reporting; Provide written acknowledgment and approval from the water system that will be providing the potable water; Provide evidence that the storage tank and associated water supply equipment are NSF approved or food storage grade, and used only for transport and/or storage of potable water; Provide satisfactory water quality sampling test results. The water storage tank and water supply must be at the event site 48 hours prior to the start of the event in order to obtain a water sample for testing. The water storage tank will be subject to a bacteria and free chlorine residual test that meet public health safety standards. Sampling results must be absent for total coliform bacteria and show a free chlorine residual of at least 0.5ppm to 2.0ppm. Sample results must be reported to JCPH the day before the event. Applicable technical assistance fee will be charged if water sampling is performed by JCPH staff. i. Rides ________ How many __________ Type _____________________________________________ j. Staging/Scaffolding _______ How many __________ Height _________________________________ k. Tents/Canopies _______ How many __________ Size ______________________________________ l. Vehicles _______ How many __________ Type ____________________________________________ m. Noise exemption in JCC 8.70.060 applies? No _____ Yes _____ Basis for variance request and hours limitation _______________________________________________ n. Permit fee from JCC 8.20.120 required? No _____ Yes _____ Fee due: $_____________ 300 to 1,000 Persons: $100.00 1,000 to 5,000 Persons: $500.00 5,000 persons and over: $1,500.00 Event Name: __________________________________________________________________________ 8. Public Safety a. Attach a clear, legible site and/or route map with the following indicated: North, indicated by directional arrow Names of streets with one-way streets marked Number and placement of barricades Any other details you think will be helpful b. What are your plans for on-site security, monitors, and route control? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ c. What are your plans for medical assistance? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ d. Discuss your parking plans for participants and spectators. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ e. List any additional information which the Special Event Committee may find reasonably necessary for a fair determination of whether a permit should be issued. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 9. Insurance Information – Provide a copy Name of Insurance Agent _______________________________________________________________ Address ______________________________________________________________________________ Phone _________________________________________Contact Person _________________________ Name of Insurance Company _____________________________________________________________ Policy Number __________________________ Will liquor be served at this event? Yes _____ No _____ Jefferson County Special Event Application: 8.10.12 Page 4 of 4 Event Name: _________________________________________________________________________ 10. Garbage and Recycling Are you providing garbage and recycling containers? Yes _____ No _____ If yes, please describe, including the company name of the service provider: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Trash containers shall be provided. They shall be maintained and covered to prevent discharge into the environment. All trash shall be disposed of at an approved facility. Trash containers shall be provided in all camping areas and in the stage and vendors areas. They shall be maintained and covered to prevent discharge into the environment. All trash shall be disposed of at an approved facility. 11. Traffic Control Plan Police officers are required at all signalized intersections. Flaggers are required at all non-signalized intersections. Monitors may be required at driveway entrances and other pedestrian and vehicle access points. Traffic Control Specify if Monitor, Flagger, or Police Officer Location Duties