Free 15832.xls - Indiana

APPLICATION FOR RECREATIONAL EVENTS ON PUBLIC WATERS
State form 15832 (R6 / 9-05) INSTRUCTIONS: Application must be delivered no later than 60 days prior to the proposed event to: Department of Natural Resources Law Enforcement Division Indiana Government Center South 402 W. Washington St. Rm. W-255D Indianapolis, IN 46204 Telephone: (317) 232-4010

Pursuant to IC 14-15-7-1 / 312 IAC 5-3 / IC 14-16-1 Please print clearly, illegible applications will be returned for correction.
Name of Applicant Address (number and street) (City, State, ZIP Code) Name of Organization

Telephone number (Include area code)

Request permission to conduct the following event on the public water or frozen surface of public waters of the State of Indiana. Motorboat Race Raft Race Sailboat / Wind Surfer Race Flotillas (Watercraft Parades) Ski Show / Competitive Skiing Fireworks Display Canoe / Kayak Race Ice Race (Boat, Snowmobile, Motorcycle)

Other (Describe) _________________________________________________________________________________________________

The event will be held on _________________________________________________ at ______________________________________
Date(s) - Attach schedule of dates and time if more than one day. Describe name in full Approximate Start & Ending Times City and County Acres / Length and width in yards

On the waters of _____________________________________ at ________________________________________________________. The course over which the requested event will be conducted is approximately ______________________________________________ and located in the vicinity of _________________________________________________________________. Alternate dates(s) in case
Describe nearest reference point(s)

primary dates are in conflict with other events or inclement weather_______________________________________________________
Alternate date(s)

1. The applicant shall attach, on the reverse side of this application, a detailed sketch of the area over which the proposed event will be conducted. The sketch shall provide a detailed description of the course. The sketch should include the location in respect to swimming beaches, docks, piers, or other structures used by the general public. 2. The applicant shall attach on the reverse side of this application, proof of publication for the public notice pursuant to 312 IAC 5-3-3. 3. If waiver of the personal flotation device requirement for the event is necessary the applicant shall comply with the provisions of 312 IAC 14-15-2-6 (c). Enclose the stipulated documentation together with this application. Public Notice to be published ,

Applicant or Organization name to conduct a on

Address

has applied to the Indiana Department of Natural Resources, Division of Law Enforcement, Under IC 14-15-7-3 and 312 IAC 5-3-1, For a permit Type of event Name of body of water . This event is scheduled to be held on , in event date(s) county.

Name of county

Any person objecting to such an event may do either or both of the following: (A) File a petition with the central office of the division requesting an informal hearing. The petition must be signed by at least twenty-five (25) individuals who are at least eighteen (18) years old and who reside in the county where the event will occur. A hearing under this clause is governed by 312 IAC 2-3. (B) Request the division notify the petitioner in writing when an initial determination is made to issue or deny the license. Following the receipt of notice under this clause, a petitioner may request administrative review of the determination under 312 IAC 3-1.

SITE INSPECTION (To be completed by Indiana Conservation Officer)
Date application received (Print name) Date of on-site inspection (Signature)

Based on my on-site inspection of_______________________________________________________________________________________
Location

I recommend this application be (attach additional pages as necessary): Approved as requested. Approved subject to the following modifications: _______________________________________________________________________ ______________________________________________________________________________________________________________ Approval of alternate date / time because: ____________________________________________________________________________ ________________________________________________________________________________________________________________ Denied for the following reasons: ___________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________
Signature of District Commander

District Commander

concurs with inspecting officer. recommends approval of application as submitted.

REGIONAL COMMANDER TO COMPLETE ONLY WHEN APPLICATION IS DENIED, MODIFIED OR USE OF ALTERNATE DATES OR TIME IS REQUESTED.

Signature of Regional Commander

Regional Commander

concurs with inspecting officer concurs with District Commander

Name of Applicant Address (number and street) (City, State, ZIP Code)

Name of Organization

Telephone number (Include area code)

YOUR APPLICATION IS: Approved (see attached permit) Approval to conduct this event is subject to your compliance with any stipulated modifications listed under "Site Inspection" above, separate correspondence and rules set forth by the American Power Boat Association, the National Outboard Motorboat Association, the United States Yacht Racing Union, similar watercraft / off-road vehicle competition governing body and / or subject to ordinances of municipality having jurisdiction. Denied for reason(s) stipulated under "Site Inspection" above. If denied, you are hereby given notice of your right to a hearing before the Director, Indiana Department of Natural Resources pursuant to IC 4-21.5.
Signature of Law Enforcement Division Director

DISTRIBUTION: Original - Applicant; Copy - Division Headquarters; Copy - District Headquarters