Special Event Camping Area Form

Kandiyohi-Renville Community Health Board
2200 23^rd 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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2024 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

Name of Event:

Location of Event:

Dates of event: From: To:

Time of Event: From: To:

Applicant's Information:

Name (individual or business):

Address:

City: State:

Zip:

Phone: Email:

Preferred method of receiving permit: Email Mail Pick-Up

Mailing address if different than above:

Mailing Address

City: State:

Zip:

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: Municipal Private Well Other, explain:

Distance from water source to farthest camp site: feet

Describe methods of liquid and solid waste disposal:

Special Event Camping Area Fee: $105 base fee plus $2 per site.

A late fee of $20 is due for any applications received less than four days prior to the event

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

ByDate

SPECIAL EVENT CAMPING AREA

REQUIREMENTS

In Special Event Camping Areas (SECA) recreational camping vehicles and tents, including their attachments, must be separated from each other and other structures by at least ten (7) feet.

In SECA a minimum site area of 300 square feet per site must be provided.

Each SECA site must abut or face a driveway or clear unoccupied space of at least 16 feet in width, which space must have unobstructed access to a public roadway.

Water must be provided by an approved source, and be located no greater than 400 feet from the farthest camp site.

Toilets must be provided in the ratio of one toilet for each sex for each 150 sites. Toilets must be no more than 400 feet from any camp site.

An adequate number of durable, covered, watertight containers must be provided for all garbage and refuse.

Garbage and refuse must be collected as often as necessary to prevent nuisance conditions.

SECA sites must not be located in areas of tall grass or noxious weeds, and sites must be adequately drained.

A responsible attendant or caretaker must be available on site for any SECA that has 50 or more sites.