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2. IMPORTANT: Please open this form in GOOGLE CHROME (Internet Explorer fails to submit properly).
4. Are you applying for a TEMPORARY STRUCTURE marine permit? (required)*

   1. YES
   2. NO

   If you answered NO and you would like to apply for a marine EVENT permit, please complete and submit the application for a Marine Event Permit.
6. APPLICATION FOR TEMPORARY STRUCTURE MARINE PERMIT
   Applications for Structure Permits must be received 10 days in advance of placing the structure. Permits are needed for the following: Mooring Buoys; 150-Foot “Perpetual No Wake Zone From All Shores” Temporary Marker Buoys; Swim Buoys; Floating Rafts; Trampolines; Ice Rink; Slalom/Waterski Course; and any other item left in the water that could be a hazard to navigation. MN Rule 6110.1800 With regard to Temporary Structures, MN Rule 6110.1800 states, “No person shall leave any temporary structure not extending from shore, or any buoy or sign in the waters of this state between the hours of sunset and sunrise without first obtaining a permit in writing therefore from the Sheriff of the county.”
8. Applicant Name*
10. Applicant Home Address (Street) (required)*
12. City (required)*
13. State (required)*
14. Zip Code (required)*
16. Applicant Phone Number (required)*
17. Applicant Email Address (required)*
    If you do not have an email address, please type "no email" in this field.
19. Type of Structure (required)*

    1. Mooring Buoy
    2. 150' Buoy
    3. Swim Buoy
    4. Floating Raft

    1. Trampoline
    2. Ice Rink
    3. Slalom/Waterski Course
    4. Other*
20. *If "Other", what is the structure?
22. Date range for temporary structure (required)*
    Date range for temporary structure (required) Start Date

    —

    Date range for temporary structure (required) End Date
24. Body of Water (required)*
    Name of lake/river/bay
25. Is this a renewal? (required)*

    1. YES
    2. NO
26. Permit Number
    Number from existing permit
28. Address of Structure Location (required)*
30. Diagram (ONLY REQUIRED FOR SLALOM/WATERSKI COURSE)

    A diagram of the area where you propose to place your slalom/waterski course is required. Your diagram should encompass the shoreline and lake area in front of your property and the two adjacent lots. Be sure to include lot lines, docks and any existing temporary structures in front of all three lots. Note any landmarks that will assist our deputies in locating your site from a boat. You must indicate the length of the shoreline between your lot lines (lake frontage) and the distance from shore to the proposed location for your structure. Indicate north with an arrow through the drawing.

31. Liability Insurance Certificate (REQUIRED FOR ALL STRUCTURES, INCLUDING BUOYS)*

    Applicant shall maintain a comprehensive liability insurance policy in the amount not less than three hundred thousand dollars ($300,000). The policy Shall remain in effect for the duration of the effective dates.   

    Applicant must email/provide a copy of the Liability Insurance Certificate to the Sheriff's Office, either in person or via email to stdemeule@co.scott.mn.us.

    1. I have provided a copy of the Liability Insurance Certificate to the Sheriff's Office
33. Written Permission from City of Prior Lake (ONLY REQUIRED FOR SLALOM/WATERSKI COURSES ON PRIOR LAKE)

    If the slalom course is located on Prior Lake, written permission MUST be obtained from the City of Prior Lake and uploaded with this form.

34. Neighbor Written Permission (REQUIRED FOR ALL BODIES OF WATER)

    All property owners which the course directly affects (neighbors) must give written permission and be uploaded with this form.

36. TERMS OF ACCEPTANCE:
    This permits, if granted, will be mailed to the address given on this application. It is important to follow the stipulations on the permit or you could be charged with a misdemeanor violation pursuant to Minn. Stat. 86B.111 and Minn. Rule 6110.1800.
38. Digital Signature (required)*

    1. I understand and accept the above terms and conditions.
    2. I do not understand and/or accept the above terms and conditions.
    3. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
    4. I the undersigned applicant, agree to defend, indemnify, and hold harmless, Scott County for any and all claims resulting from the structure specified on this application.
39. Name of Person Signing Form
    First and last name of person signing form (not name of organization). Form cannot be signed on behalf of another individual.
40. Date Signed (required)*
    Date Signed (required)
42. Next Steps
    Once submitted, your application will be processed by the Sheriff's Office and either approved or denied by our Recreational Safety Deputy and Sheriff. Please choose a delivery method on the right.
43. Delivery Method:*

    Once approved, how would you prefer your permit to be sent to you?

    1. Via email (provided above)
    2. Via mail (provided above)
    3. Via mail (alternate address below)
45. Alternate Address
    If you chose the option to have your permit delivered to an alternate address, please provide that address in the space above (include street address, city, state, zip).
47. Contact the Recreational Safety Division

    If you have any questions regarding marine permits, please contact Deputy Max Kes at the Scott County Sheriff’s Office at 952-496-8330 or email at mkes@co.scott.mn.us.

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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

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