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LOCAL FIREWORKS DISPLAY PERMIT <br /> <br /> APPLICANT: <br /> <br /> ADDRESS: <br /> <br />CITY, STATE & ZIP: <br />AREA CODE: <br /> <br />P.ONE: 03 .X <br /> <br />Request is hereby submitted to obtain your approval to conduct a Fireworks Display. <br /> <br />SPONSOR: <br /> <br />DATE OF DISPLAY: <br /> <br />APPROXIMATE STARTING TIME: <br />LOCATION OF DISPLAY: <br /> <br />, 19 <br /> <br />~-- or alternate date <br /> <br />DISPLAY OPERATOR: <br /> <br />Southern International Fireworks, Inc. <br />P.O. Box 1 <br />Woodstock, GA 30188 <br />404/924-1771~ <br /> <br />APPLICANT SIGNATURE: <br /> <br /> DATE SIGNED: <br /> <br />Perlaission has been granted for Southern International Fireworks, Inc. to conduct <br />a Fireworks Display in accordance with the above. <br /> <br />APPROVED BY: <br /> <br />Fire Prevention or Fire Chief <br /> <br />Agency <br /> <br />PI. EASE SENI}'PERMIT TO SPONSOR AND TO SOUTHERN INTERNATIONAL FIREWORKS, INC. <br /> <br /> <br />