Fireworks Permit Application Form

Payment of $25.00 in a check payable to Blue Earth County must be mailed prior to permit approval.

Checks can be mailed to:

Blue Earth County Administration

Attn: Stephanie Jahnke

PO Box 168

Mankato, MN 56002-0168

STATE OF MINNESOTA )
)ss
COUNTY OF BLUE EARTH)

In Conformity with Section 624.22 MSA, Organization/Group* does hereby apply for a permit for public fireworks display to be held at Location* in Blue Earth County on Date* between the times of Start Time* and End Time*

Name of Operator

Age

Must be at least 21 yrs.

Certification Number

List Assistants

Rows	Name	Age	Certification Number
Assistant 1
Assistant 2
Assistant 3
Assistant 4
Assistant 5

Approximate Number, Class, and Size of Fireworks to be discharged

It is understood that if because of inclement weather on the above date applicant may use this permit on

Date

Hour MinutesAM/PM Option

Please upload a diagram of the grounds.

pdf, doc, docx, xls, xlsx, csv, txt, rtf, jpg, jpeg, png, gif

Please upload a Certificate of Insurance ($1,000,000 with Blue Earth County listed as the certificate holder.

pdf, doc, docx, xls, xlsx, csv, txt, rtf, jpg, jpeg, png, gif

Signature of Applicant

Applicant Signature Date

MM/DD/YYYY

Applicant Email Address

example@example.com

Applicant Phone Number

(000) 000-0000Format: (000) 000-0000.

Applicant Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Blue Earth County Administrative Assistant Section

BEC Administrative Assistant – Please review the application and either accept or deny the request.

If you deny the application:
Reason for Denial comments will be required and will be emailed to the applicant. Please include your contact information if follow-up is needed. Denying the application will end the workflow process and will not include the BEC Sheriff or Administrator in the workflow.

If the applicant later provides satisfactory information addressing the reason for denial, you may reopen the request using the link in the original email notification for this application. You can then update the form details, including uploading documents, and change your response to accept to continue the workflow to the Sheriff.

If you accept the application:
Comments are not required. The application will be forwarded to the County Sheriff for review and approval. After the County Sheriff approves the request, it will be sent to the County Administrator for review and approval. Once the Sheriff and Adminnistrator have approved the request, a final PDF copy of the application, including all uploaded attachments, will be emailed to both you and the applicant.

If the Sheriff or Administrator deny the request, an email with their details of denial will be emailed to you (not the applicant).

NOTE: Your decision and comments will not appear on the final PDF application.

Is this application acceptable?

Reason for Denial:

Required if you select Deny.

(Optional) - upload any additional/supporting documents.

pdf, doc, docx, xls, xlsx, csv, txt, rtf, jpg, jpeg, png, gif

Blue Earth County Sheriff Section

BEC Sheriff – If you Approve the application, enter details (date) in the opinion section below and your name, then click Submit to send the completed form to the BEC Administratator for review.

If you Deny the application, please provide a Reason for Denial, then click Submit to send the application back to the BEC County Administrative Assistant.

Note: Your denial and reason will not appear on the final PDF application. The details of the denial will only be emailed back to the Administrative Assistance. They will reach out to the applicant.

Sheriff Approve or Deny?

In my opinion, the applicant is competent, and the display as planned will conform to safety requirements. The above application for permit is hereby granted. Dated at Mankato, Minnesota, this Dayday of , 20
Year

Reason for Sheriff Denial:

Required if you select Deny.

Blue Earth County Sheriff

Blue Earth County Administrator Section

BEC Administrator – If you Approve the application, please enter your name and date below, then click Submit to send the completed application to the submitter and Administrative Assistance.

If you Deny the application, please provide a Reason for Denial, then click Submit to send the application back to the BEC County Administrative Assistant.

Note: Your denial and reason will not appear on the final PDF application. The details of the denial will only be emailed back to the Administrative Assistance. They will reach out to the applicant.

County Administrator Approve or Deny?

Reason for County Administrator Denial:

Required if you select Deny.

Blue Earth County Administrator

Administrator Date

MM/DD/YYYY

Payment of $25.00 in a check payable to Blue Earth County must be mailed prior to permit approval.

Checks can be mailed to:

Blue Earth County Administration

Attn: Stephanie Jahnke

PO Box 168

Mankato, MN 56002-0168

FIREWORKS PERMIT APPLICATION