E-APPLICATION AND LICENSING
Developed By CPUI
Ver 01/30/2018
Kandiyohi-Renville Community Health Board
2200 23rd Street NE Suite 1080, Willmar, MN 56201
www.co.kandiyohi.mn.us — www.co.renville.mn.us
Kandiyohi County: 320.231.7800
Renville County: 320.523.2570
publichealth@co.kandiyohi.mn.us — rcph@renvillecountymn.com
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2019 Special Event Camping Area Application

Requests are limited to two camping events annually not to exceed fourteen consecutive days. Requests must be submitted thirty days in advance of the event. A diagram of the campground, including location of drinking water, toilets, roads and campsites must be submitted with the application.


Event Information

Location of Event:

Dates of event: From: To:

Time of Event: From: To:

Applicant's Information:

Name (individual or business):

Address:

City:

Zip:

Phone: Email:

Preferred method of receiving permit:

Mailing address if different than above:

Campsite Information:

Number of campsites:

Number of square feet per campsite:

If 50 or more campsites, provide the name of the responsible attendant or caretaker:

Each campsite will abut a driveway or clear unoccupied space of at least feet in width, which space will have unobstructed access to a public roadway.

Toilets

Type of toilet facility provided:

Number of toilet facilities provided:

Distance from toilet to farthest camp site: feet

Water

Private Wells must be tested for total coliform bacteria and nitrates. Results of tests must be submitted to this office.

How is water going to be provided?

Water Source:

Distance from water source to farthest camp site: feet

Describe methods of liquid and solid waste disposal:

Special Event Camping Area Fee: $72 base fee plus $2 per site.

Checks payable to: Kandiyohi - Renville Community Health Board; mail to the address above

This variance request is approved only for operation as specified above; additional approval is required for any changes.

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This is to certify that I am the individual who is the subject/business owner of the requested application.

This statement is to certify that all of the information in this application is true and correct and has been provided by the above named subject/business owner.

I certify that the information provided on this application is accurate and complete.

Online Application Completed

SPECIAL EVENT CAMPING AREA

REQUIREMENTS