Special Use of Reserves Permit

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Contact Person

Mailing Address

City

Postal Code

Phone

***

Have you made an application in the past?

Have you made an application in the past? NoHave you made an application in the past? Yes

Were registration numbers issued by the County if purpose was winter storage?

Were registration numbers issued by the County if purpose was winter storage? NoWere registration numbers issued by the County if purpose was winter storage? Yes

Previous registration number(s) received:

Reserve location (nearest subdivision or legal land location):

Reserve Location Other

Date of use:

Winter Storage (Sept Long to May Long)?

Winter Storage (Sept Long to May Long)? NoWinter Storage (Sept Long to May Long)? Yes

Other (Specify Timing):

Description of event (select all that apply):

Boat Lift Storage (count):

Event Type (if other):

Dock Storage (count):

Details:

Is camping or overnight use planned?

Is camping or overnight use planned? NoIs camping or overnight use planned? Yes

Are neighboring residents aware of this event?

Are neighboring residents aware of this event? NoAre neighboring residents aware of this event? Yes

I agree to the following:

That I have read and will abide by Lacombe County's Policy RC (8) - Use and Management of County Reserve Lands.
To ensure that no detrimental impacts are made to the site.
To only occupy the reserve on date(s) indicated above.

Yes (check this box to indicate that you agree)

The personal information on this form is collected under Alberta's Freedom of Information and Protection of Privacy Act (FOIP) and will be used for the purpose of carrying out your request. Should you have any questions regarding FOIP please phone 403.782.6601 and ask for the FOIP Coordinator.