Get Nh Swim Raft Permit Application

State of New Hampshire DEPARTMENT OF SAFETY DIVISION OF STATE POLICE MARINE PATROL 31 DOCK ROAD GILFORD N.H. 03249-7627 John J. Barthelmes Commission of Safety APPLICATION FOR SWIM LINE PERMIT PLEASE TYPE OR PRINT NOTE Swim Line Permits are required on ALL public bodies of water. State of New Hampshire DEPARTMENT OF SAFETY DIVISION OF STATE POLICE MARINE PATROL 31 DOCK ROAD GILFORD N*H. 03249-7627 John J* Barthelmes Commission of Safety APPLICATION FOR SWIM LINE PERMIT PLEASE TYPE OR PRINT NOTE Swim Line Permits are required on ALL public bodies of water. DIRECTIONS Complete this form and return it to the address indicated above. INCOMPLETE APPLICATIONS WILL BE RETURNED. 1. Check One This is a NEW application RENEWAL application 2. Type of swim area for which permit is requested a* Private / Individual c* Public b. Private Group / Association Town Owned State Owned Name of Association 3. a* Property Owner DOB Mailing Address Town b. Person completing application Evening Phone State Zip Day phone 4. Swim Line Location a* Body of Water b. Shorefront Property Street Address c* Lot Number and Tax Map Number d. Name / address of abutters to your shore front property DSSS 41 Rev*07/12 UNLESS A SWIM LINE VARIANCE IS REQUESTED AND APPROVED NO SWIM LINE SHALL BE PLACED BEYOND THE POINT WHERE THE DEPTH OF WATER EXCEEDS 6 FEET OR FOR A DISTANCE FROM SHORE OF 50 FEET WHICHEVER OCCURS FIRST. SWIM LINES NOT PLACED IN ACCORDANCE WITH THE TERMS OF THE APPROVED PERMIT MAY BE REMOVED AND THE SWIM LINE PERMIT REVOKED 5. Please complete the following check one a* Are you requesting a variance Yes No b. If you are requesting a variance please clearly state the reason s for this request. You must also descriptively state the water depth and distance from shore at the point where you are requesting that the swim line be located Saf-C 404. 08. 4. Please provide a diagram / map which shows the following The map must be accurate in relation to North d. Your shore line and property lines indicate feet. Proposed location of swim line and depth of water in feet. Length of swim line. Locations dimensions and distance in feet of moorings docks boat houses breakwaters located off your shore front. e. The shore lines and property lines of your abutters in feet. off your abutters water fronts. g. Unsigned applications will be returned* Signature of Applicant Date DIAGRAM N With an arrow please indicate North FOR OFFICIAL USE ONLY Applicant 1. Field investigation notes 2. Approval status recommendation Approve as submitted* Approve with the same conditions as prior years Deny Please provide reason for recommendation of denial* Signed. 03249-7627 John J* Barthelmes Commission of Safety APPLICATION FOR SWIM LINE PERMIT PLEASE TYPE OR PRINT NOTE Swim Line Permits are required on ALL public bodies of water. DIRECTIONS Complete this form and return it to the address indicated above. INCOMPLETE APPLICATIONS WILL BE RETURNED. DIRECTIONS Complete this form and return it to the address indicated above. INCOMPLETE APPLICATIONS WILL BE RETURNED. 1. Check One This is a NEW application RENEWAL application 2. Type of swim area for which permit is requested a* Private / Individual c* Public b.