Land Use Permit Application

2. Please submit completed application via email to Laurie Offenbach at loffenbach@marinwater.org. For questions, call (415) 945-1180.

   Please submit completed application via email to Laurie Offenbach at loffenbach@marinwater.org. For questions, call (415) 945-1180.

4. Today's Date*
   Today's Date

6. APPLICANT INFORMATION

8. Contact Name & Title*

9. Email*

11. Primary Phone*

12. Secondary Phone

14. Company or Agency Name

16. Address*

18. City*

19. State*

20. ZIP*

22. ACTIVITY / EVENT*

    Check all that apply.

    1. Filming
    2. Still Photography
    3. Bicycling

    1. Fundraising
    2. Youth Education or Camp

    1. Hiking
    2. Commercial Outdoor Recreation

    1. Wedding
    2. Other activity (please describe below)
23. 1. Please describe the activity or event*

25. 2. Date of activity or event*
    2. Date of activity or event

26. Start time / stop time*
    Start time / stop time Start Time

    —

    Start time / stop time End Time

28. 3. Number of people*

29. Charging participants?

    1. Yes
    2. No

30. Fee amount

32. 4. Location of activity or event*

    Describe the approximate location desired, referring to the nearest fire roads, trails or mile markers. Note: For film shoots, map and photos of filming location(s) must be provided.

34. 5. Staging location

36. 6. Number of vehicles and type of equipment needed (check all that apply)

    1. Vehicle
    2. Recreational Vehicle

    1. Trailer
    2. Helicopter

    1. Other

38. Number of vehicles

39. Number of trailers

41. Number of recreational vehicles:

43. If you checked Other, please describe

45. Need helicopter pad?

    1. Yes
    2. No

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field