Camp / Temporary Place of Abode Permit Application

Camp / Temporary Place of Abode Permit Application

Pursuant to Chapter 61 of the Town Code, a permit must be obtained before establishing or maintaining a camp or temporary or permanent place of abode in a trailer, house trailer, tent, wagon, van, automobile, or truck within the corporate limits of the Town of Galena. Permits are limited to five (5) days, may be used only on private property, and may not be renewed. Violations are subject to the penalties established by Chapter 61 of the Town Code.
Applicant Name

First NameLast Name
Applicant Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email
example@example.com
Address Where Temporary Abode will be Located:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Owner Name

First NameLast Name
Type of Temporary Place of Abode:

Other
Purpose of Temporary Stay:
Requested Start Date (Permit may not exceed 5 days)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Number of persons who will be staying / sleeping at the location
Names of occupants
Vehicle / Trailer Make & Model (if applicable)
License Plate / Registration No. (if applicable)
Please upload a signed authorization from the property owner:

Cancelof
APPLICANT CERTIFICATION

I certify that the information provided in this application is true and complete. I understand and agree that:
- A permit is required before establishing or maintaining a camp or temporary or permanent place of abode in a trailer, house trailer, tent, wagon, van, automobile, truck, or similar arrangement within the corporate limites of the Town of Galena.
- The permit is valid for no more than five (5) days.
- The temporary place of abode must be located on private property.
- A permit issued under Chapter 61 may not be renewed.
- Issuance of this permit does not authorize any activity otherwise prohibited by applicable Town, County, State, or federal law.
- Violations of Chapter 61 may constitute a municipal infraction and may be subject to applicable fines and penalties.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: