Fillable Printable Form 1583

Form 1583

Page 1 of 2

APPLICATION FOR RECREATIONAL EVENTS

ON PUBLIC WATERS

Pursuant to IC 14-15-7-1, 312 IAC 5-3, and IC 14-16-1

State form 15832 (R8 / 5-17)

DEPARTMENT OF NATURAL RESOURCES

LAW ENFORCEMENT DIVISION

Indiana Government Center South

402 West Washington Street, Room W255D

Indianapolis, IN 46204

Telephone: (317) 232-4010

INSTRUCTIONS: 1. This application must be delivered to the Law Enforcement Division at the above address no later than sixty (60) days prior to

the proposed event.

2. Please print clearly, illegible applications will be returned for correction.

Name of applicant Name of organization

Address (number and street, city, state, and ZIP code) Telephone number

( )

Request permission to conduct the following event on the public water or frozen surface of public waters of the State of Indiana:

Motorboat Race Sailboat / Wind Surfer Race Ski Show / Competitive Skiing Canoe / Kayak Race

Raft Race Flotillas (Watercraft Parades) Fireworks Display Ice Race (Boat, Snowmobile, Motorcycle)

Other (Describe): _________________________________________________________________________

The event will be held on ___________________________________________________________________________________________________

Date(s) (month, day, year) Attach schedule of dates and time if more than one day.

at _______________________________________________

on the waters of _________________________________________________________

Approximate start and ending times Describe name in full.

at _______________________________________________________.

City and County

The course over which the requested event will be conducted is approximately _________________________________________________________

Acres / length and width in yards

and located in the vicinity of _________________________________________________________________________________________________.

Describe nearest reference point(s).

Alternate dates(s) in case primary dates are in conflict with other events or inclement weather:

________________________________________________________________________________________________________________________

Alternate date(s) (month, day, year)

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 IC 14-15-2-6 (c).

Enclose the stipulated documentation together with this application.

PUBLIC NOTICE TO BE PUBLISHED

_____________________________________________________________, __________________________________________________________

Applicant or Organization name Address (number and street, city, state, and ZIP code)

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 to

conduct a _____________________________________________________. This event is scheduled to be held on ____________________________

Type of event Event date(s) (month, day, year)

on ___________________________________________________________, in _________________________________________________ county.

Name of body of water 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.

Reset Form

Page 2 of 2

SITE INSPECTION (To be completed by Indiana Conservation Officer.)

Date application received (month, day, year) Date of on-site inspection (month, day, year)

Printed name of inspecting officer Signature of inspecting officer

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: _____________________________________________________________________________________

________________________________________________________________________________________________________________

District Commander:

concurs with inspecting officer.

recommends approval of application as submitted.

Signature of District Commander

REGIONAL COMMANDER TO COMPLETE WHEN DENIAL, MODIFICATION OR USE OF ALTERNATE DATES OR TIMES ARE REQUESTED.

Regional Commander:

concurs with inspecting officer.

concurs with District Commander.

Signature of Regional Commander

DECISION

Name of applicant Name of organization

Address (number and street, city, state, and ZIP code) Telephone number

( )

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 Date (month, day, year)