TOWN OF SOUTHBURY
501 Main Street South
Southbury, Connecticut 06488
(203) 262-0647
Fax: (203) 264-9762
REQUEST TO USE TOWN OWNED PROPERTIES
This packet has been prepared in an effort to streamline and track the many requests
the Town receives to use Town-owned property for various functions and events.
If you wish to schedule an event or function on any property owned by the Town of
Southbury, you are required to fill out this form in its entirety and submit it to the
appropriate departments and organizations for their approval:
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Fill in page 1 of the form, providing as much detailed information as possible.
Print out both sides of the completed form and deliver to the First Selectman’s
Office at 501 Main Street South.
The form and the information provided will be reviewed and you will be notified
which departments or organizations will need to review/approve the application.
Some departments may require additional details on your planned activities before
issuing an approval.
Some departments may also need to issue a permit for the activities you have
planned.
Use of most of Town-owned properties is free of charge, however, there is a fee to
reserve the use of the Ballantine Park Pavilion.
You will also be advised when the Insurance Certificate is required.
As this process is a new one, we invite any comments and suggestions you may have to
make this more user-friendly and less cumbersome. Please call the First Selectman’s
Office with any questions or comments: 203-262-0647.
Request To Use Town Owned Properties
Page 1
FORM TO REQUEST TO USE TOWN OWNED PROPERTIES
Town Property Requested: Choose an item.
If Other, please specify: Click here to enter text.
Applicant: Click here to enter text.
Name of Group/Business: Click here to enter text.
Address: Click here to enter text.
Telephone: Click here to enter text.
Email: Click here to enter text.
Date of Event: Click here to enter a date.
Enter Time: Click here to enter text. Depart Time: Click here to enter text.
Proposed Use: Click here to enter text.
Number of people expected: Click here to enter text.
Will Alcohol be served: Choose an item.
Please note: Sale of alcohol on Town properties is prohibited.
Will Food be served: Choose an item.
Will Food be sold: Choose an item.
What Equipment, if any, will you bring to the site: Click here to enter text.
Tent or Temporary Structures: Choose an item. If yes, specify size: Click here to
enter text.
Is off site advertising planned: Choose an item.
If yes, describe: Click here to enter text.
I understand that I will be held responsible for any damages and that I must leave the
facility/grounds in a clean and orderly condition. I also agree to hold harmless the
Town of Southbury, its officers, agents, employees from any claim or liability that may
arise from the use of town property.
Applicant Signature
Accepted by: _________________________
Request To Use Town Owned Properties
Date
Date: _______________
Page 2
Review/Comments
(You will be instructed which department needs to sign off)
Building Official
Fire Marshal
Zoning Enforcement/Wetlands
Land Use Administrator
Parks & Recreation
Police Department
Fire Department
Public Works
Health Department
First Selectman
Insurance Certificate Provided:
A certificate of Insurance-Bodily Injury/Property Damage, with a minimum of $1,000,000
is required, with the following statement: “The Town of Southbury is additionally
insured”.
Request To Use Town Owned Properties
Page 3