Address where tents will be located * Name * Landowners name * Phone Number * Signature * I understand and acknowledge there are limitations and regulations set forth by the city of Pottsville. I have read and understand the ordinance 2013-1. Any violations of this ordinance may result in fines from $50 to $500. I agree to abide by all state codes and fire codes within the city limits. Firework sales shall be from June 28th to July 10th at midnight. Please make sure all no smoking signs, fire extinguishers, and the 2013-1 city ordinance is displayed as they should be. Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Leave this field blank
