Form SLAP 22.62/.63 Application for Marine Event Permit - Nevada

Form SLAP22.62/.63 or the "Application For Marine Event Permit" is a form issued by the Nevada Department of Wildlife.

The form was last revised in October 1, 2010 and is available for digital filing. Download an up-to-date Form SLAP22.62/.63 in PDF-format down below or look it up on the Nevada Department of Wildlife Forms website.

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____________________________________________________________________________________________________________
APPLICATION
MARINE EVENT PERMIT
Fee: Marine Event - $50 (22.62)
Marine Event Charitable Organization – No Charge (22.63)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
APPLICANT INFORMATION
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
NAME [LAST]
[FIRST]
[MIDDLE]
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
:
HOME PHONE
WORK PHONE
E-MAIL ADDRESS
:
:
:
:
:
HEIGHT
WEIGHT
HAIR
EYES
GENDER
:
:
DRIVER’S LICENSE NUMBER
STATE
DATE ISSUED
1. Have you conducted any marine events prior to this application
Yes
No If yes, please list them:
2. Have you ever been convicted of a boating safety violation, an alcohol/drug-related offence or any felony?
Yes
No If yes, please list them:
3. Name of Organization:
4. Location of Event:
5. Exact Times:
6. Exact Dates:
7. Description:
As part of the description attach a diagram showing boundaries of the event, water courses, buoy placement,
areas for participation, officials, and spectators.
8. Estimated number of vessels:
A. Participants:
Participant vessel types and classes:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.62/.63
Rev. Oct 2010
Page 1 of 3
____________________________________________________________________________________________________________
APPLICATION
MARINE EVENT PERMIT
Fee: Marine Event - $50 (22.62)
Marine Event Charitable Organization – No Charge (22.63)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
APPLICANT INFORMATION
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
NAME [LAST]
[FIRST]
[MIDDLE]
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
:
HOME PHONE
WORK PHONE
E-MAIL ADDRESS
:
:
:
:
:
HEIGHT
WEIGHT
HAIR
EYES
GENDER
:
:
DRIVER’S LICENSE NUMBER
STATE
DATE ISSUED
1. Have you conducted any marine events prior to this application
Yes
No If yes, please list them:
2. Have you ever been convicted of a boating safety violation, an alcohol/drug-related offence or any felony?
Yes
No If yes, please list them:
3. Name of Organization:
4. Location of Event:
5. Exact Times:
6. Exact Dates:
7. Description:
As part of the description attach a diagram showing boundaries of the event, water courses, buoy placement,
areas for participation, officials, and spectators.
8. Estimated number of vessels:
A. Participants:
Participant vessel types and classes:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.62/.63
Rev. Oct 2010
Page 1 of 3
B. Spectators:
C. Safety Patrol:
9. Estimated number of participants:
10. Estimated number of spectators:
11. Special Requirements: (i.e. restricted movement of vessels and spectators through specified areas:
12. Motorboat noise exemption is hereby requested:
to compete in an approved marine event as provided in NRS 488.305.
to conduct trial runs between the hours of 9 a.m. and 5 p.m. for a period not to exceed 48 hours
immediately preceding the marine event.
to compete in official trials for speed records between the hours of 9 a.m. and 5 p.m. for the period not to
exceed 48 hours immediately following the marine event.
13.
Safety requirements (i.e. safety patrols, unusual hazards, radio coordination, launching/retrieving buoys,
the number and kind of navigational aids, rescue, medicinal, picket boats):
14. Do you have liability insurance?
Yes
No Amount:
Insurer:
Insured:
15. Are there any potential adverse environmental effects or pollution concerns that may require an
environmental assessment?
Yes
No If yes, describe (include any abatement plans)
16. Public sanitation concerns will be addressed as follows:
17. Have you contacted other agencies that may require a permit?
Yes
No If yes, agency name:
I, the signator, in signing this application, hereby state that I am entitled to this permit under the laws of the
State of Nevada and that no false information or false statement has been made by me to obtain this license.
_____________________________________________________________
__________________________________
Signature of Applicant
Date
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.62/.63
Rev. Oct 2010
Page 2 of 3
Submit your completed application and fee to the appropriate office below:
Western Region
Southern Region
Nevada Department of Wildlife
Nevada Department of Wildlife
Special Licenses and Permits
4747 Vegas Dr.; Las Vegas, NV 89108
1100 Valley Rd, Reno, NV 89512
Telephone: (702) 486-5127
Telephone: (775) 688-1500
Counties: Clark, Esmeralda, Lincoln, Nye
Counties: Carson City, Churchill, Douglas,
Humboldt, Lyon, Mineral, Pershing, Storey,
Washoe
Eastern Region
Nevada Department of Wildlife
60 Youth Center Road; Elko, NV 89801
Telephone: (775) 777-2300
Counties: Elko, Eureka, Lander, White Pine
FOR DEPARTMENT USE ONLY
Date Received: _______________
Date Approved: _______________
Date Returned for Additional Information: _______________
Date Disapproved: _______________
Department Representative:_________________________________
REASON FOR DISAPPROVAL:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.62/.63
Rev. Oct 2010
Page 3 of 3

Download Form SLAP 22.62/.63 Application for Marine Event Permit - Nevada

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