Activity Permit Application

PERMITTEE/APPLICANT INFORMATION (PERMIT HOLDER)

APPLICANT'S REPRESENTATIVE OR AGENT (PARTY SUBMITTING THE APPLICATION)

SITE INFORMATION NOTE: You must enter a valid SITE ADDRESS, SUBDIVISION or CROSS STREET for your application to be processed.

* Site Address	* Subdivision
* Cross Streets	* Township	* Range * Section
Directions to Site	Click here to determine Township/Range/Section
* Site Contact	* Phone
* Est. Start Date	* End Date
Intended Use of the Site After Completion

PERMIT SPECIFICATIONS

CERTIFICATION

* I certify that I understand and will abide by the permit regulations.

PERMIT FEE

Total Permit Fee: $	Deferred Account <- What's this?