Section 1 of 1 in this document

Special Variance Permit Application

for Noise Ordinance Exceedance

No permit shall be granted to allow noise exceedance to continue past 11:00pm.

No more than four (4) specific events may be requested in a single application.

Cost: $30 per application (up to 4 events) plus 2.8% payment processing fee.

Note: Outdoor entertainment which is already covered by a City of De Pere "Special Event" permit would not be required to complete this application.

Name of Business (if applicable):

Applicant Phone Number:

Type of Event:

Date(s) of Event:

Time(s) of Operation:

Reason for noncompliance with noise ordinance:

Describe steps applicant can reasonably take to minimize noise:

Immediate adjacent neighbors notified:

Yes

Equipment and operation involved:

Notes Section:

Name of responsible person who will be in attendance at event:

Contact phone number while on site:

Do you need to apply for a second event?

Yes

Event #2

Type of Event (#2):

Date(s) of Event (#2):

Time(s) of Operation (#2):

Reason for noncompliance with noise ordinance (#2):

Describe steps applicant can reasonably take to minimize noise (#2):

Immediate adjacent neighbors notified (#2):

Yes

Equipment and operation involved (#2):

Notes Section (#2):

Name of responsible person who will be in attendance at event (#2):

Contact phone number while on site (#2):

Do you need to apply for a third event?

Yes

Event #3

Type of Event (#3):

Date(s) of Event (#3):

Time(s) of Operation (#3):

Reason for noncompliance with noise ordinance (#3):

Describe steps applicant can reasonably take to minimize noise (#3):

Immediate adjacent neighbors notified (#3):

Yes

Equipment and operation involved (#3):

Notes Section (#3):

Name of responsible person who will be in attendance at event (#3):

Contact phone number while on site (#3):

Do you need to apply for a fourth event?

Yes

Event #4

Type of Event (#4):

Date(s) of Event (#4):

Time(s) of Operation (#4):

Reason for noncompliance with noise ordinance (#4):

Describe steps applicant can reasonably take to minimize noise (#4):

Immediate adjacent neighbors notified (#4):

Yes

Equipment and operation involved (#4):

Notes Section (#4):

Name of responsible person who will be in attendance at event (#4):

Contact phone number while on site (#4):

Applicant Signature:

First Name

Last Name

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