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LOCAL FIREWORKS DISPLAY PERMIT <br /> <br /> A]PPLICANT: <br /> <br /> ADDRESS: <br /> <br />CITY, STATE & ZIP: <br />AREA CODE: <br /> <br /> 249 <br /> <br />F©L~.S ~,.~' 28082 <br /> <br />(704) PHONE: 932-4164 <br /> <br />Request is hereby submitted to obtain your approval to conduct a Fireworks Display. <br />SPONSOR: . <br /> <br />DATE OF DISPLAY: ~.~'~Y 9 , 19 92 or alternate date r~3ne <br /> <br />APPROXIMATE STARTING TIM. E: 9:30 ~.q <br /> <br />LOCATION OF DISPLAY: FIEL,~CPEST CC,AR,ION PAPKING ~ AC.-...~. ~ ChNNON PADK <br /> <br />DISPLAY OPERATOR: <br /> <br />APPLICANT SIGNATURE: <br /> <br /> DATE SIGN~: <br /> <br />Southern International Fireworks, Inc. <br />P.O. Box One <br />Woodstock, GA ~0188 , <br /> <br /> 7,1 7,- <br /> <br />Permission has been granted for Southern International Fireworks, Inc. to conduct <br />a Fireworks Display in accordance with the above. <br /> <br />AP~!~D BY: <br />Fire Pr~ent&n or Fire Chief <br /> <br />Agency <br /> <br />Date Signed <br /> <br />PLEASE SEND COPY OF PERMIT TO SPONSOR ~_ND SOUTHERN INTERNATIONAL FIREWORK-S, INC. <br /> P.O. Box One Woodstock, GA 30188 <br /> <br /> <br />