Office of Fishing and Boating Access

Special Use Permit Application
Month Day Year Hour Minutes
Event Date Type *

Single Day Event Recurring Weekday Event
Event Start Date *

Month Day Year
Recurring Weekday

Monday Tuesday Wednesday Thursday Friday
Event End Date

Month Day Year
Full Name of Organization *
Please use Full Organization Name
Waterbody *
Permit Season: *

Summer Winter
Number of Vehicles *
Must record at least 1 Vehicle
Number of Boats *
More than 25 vessels will require an Environmental Police Detail.
Number of ATV's/Snowmobiles *
More than 1 ATV or Snowmobile will require an Environmental Police Detail.
Number of Participants *
(WINTER EVENTS ONLY)
Public Welcome? *

Members Only Event Open Event
Arrival Time *

: Hour Minutes AM/PM Option
Start Time *

: Hour Minutes AM/PM Option
End Time *

: Hour Minutes AM/PM Option
Type of Event *
If Other, Please Specify *
Event Information

Contact Information
Firstname *
Lastname *
Mailing Address *
City *
State *
Zip Code *
Daytime Phone *
E-mail *
*In consideration of the use of the state boat launching facility aforementioned, the individual/organization responsible for this event herby releases the Commonwealth and the Managing Authority, it’s officers and employees, from all liability and claims of any kind arising out of the use of this facility for this event. FBA facilities are not maintained (plowed) in winter months. Winter use is at the risk of the Applicant and participants.
Should be Empty: