Form Center

2. Please use this form to submit you comments, question or concern on this Permit
4. Event Name:*
6. Contact Information
8. Sign Off Agency*
   -- Select One --Clear Creek County Attorney's OfficeClear Creek County Environmental HealthClear Creek County Open SpaceClear Creek County Road and BridgeClear Creek County Sheriff's OfficeClear Creek County Trails DepartmentClear Creek EMSClear Creek Fire AuthorityCity of Idaho SpringsColorado Department of TransportationColorado State PatrolEvergreen Fire Protection DistrictTown of EmpireTown of GeorgetownTown of SilverplumeUnited States Forest ServiceOther
10. Sign Off Agency*
12. Full Name of Person Signing Off:*
14. Title of Person Signing Off:
16. Email Address*
18. Telephone Number:*
20. Response Information
22. Does Your Agency Approve of Deny the Event?*

    1. This agency approves the event in question
    2. This agency denies the event in question
    3. This agency conditionally approves the event in question
24. Rationale for Denying the Special Event*
26. Conditions of event approval*
28. Does your agency require an additional permit for this event?*

    1. Yes

    1. No
29. Has your agency issued that permit?*

    1. Yes
    2. No
31. Is your agency's approval contingent on that permit being issued?*

    1. Yes
    2. No
    3. Not a requirement of County permit
33. Have you reviewed and approved the Event Site Map?*

    1. Yes
    2. No
    3. See Comments
34. Have you reviewed and approved the Operations Plan?*

    1. Yes
    2. No
    3. See Comments
36. Comments
38. Does your agency require any fees to be paid?*

    Please notify the applicant of any fees due to the Agency.

    1. Yes

    1. No
39. If "Yes", is this fee to be collected by County event administrator?*

    1. Yes
    2. No
    3. Yes, but the amount has not yet been determined
40. If Yes, please provide ther amount to be charged:
42. Would you like to be contacted in reference to this response?*

    1. Yes

    1. No
43. Contact Preference:

    1. Phone

    1. Email
45. Please describe any additional comments, concerns or requirements for this permit.
47. Any supporting documentation
Leave This Blank:


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

    This field is not part of the form submission.

51. Submit

* indicates a required field