Form Dsss 41 is a document that is filled out in order to request the release of a specific person from incarceration. This form can be used for both state and federal inmates, and must be filled out completely in order to be processed. The form can be downloaded online, or picked up at your local courthouse. There are specific instructions on how to fill out the form, so it is important to read through them carefully. Additionally, there are fees associated with filing this request, so make sure you have the funds available before you start the process. If you would like to have someone released from prison, Form Dsss 41 is the document you will need. This form can be used for both state and federal inmates, and must be filled out correctly in order to be processed. There are specific instructions on how to fill out the form, so it is important that you read through them carefully before starting anything. There are also fees associated with this process, so make sure you have th
| Question | Answer |
|---|---|
| Form Name | Form Dsss 41 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | state of nh swim line permit, nh swim raft permit, GILFORD, saf |
State of New Hampshire
DEPARTMENT OF SAFETY
DIVISION OF STATE POLICE
MARINE PATROL
31 DOCK ROAD
GILFORD, N.H.
John J. Barthelmes
Commission of Safety APPLICATION FOR SWIM LINE PERMIT
(PLEASE TYPE OR PRINT)
NOTE: Swim Line Permits are required on ALL public bodies of water.
DIRECTIONS: Complete this form and return it to the address indicated above.
INCOMPLETE APPLICATIONS WILL BE RETURNED.
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Check One: This is a |
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NEW application |
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RENEWAL application |
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Type of swim area for which permit is requested: |
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a. |
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Private / Individual |
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Public: |
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Town Owned |
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b. |
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Private Group / Association |
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State Owned |
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Name of Association: |
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3. a. Property Owner: |
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DOB: |
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Day Phone: |
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Mailing Address: |
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Evening Phone: |
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b. Person completing application: |
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DOB: |
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Day phone: |
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Mailing Address: |
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Evening Phone: |
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4.Swim Line Location:
a.Body of Water:
b.Shorefront Property Street Address:
Town: |
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State: |
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Zip: |
c.Lot Number and Tax Map Number:
d.Name / address of abutters to your shore front property: 1.
2.
DSSS 41 (Rev.07/12)
UNLESS A SWIM LINE VARIANCE IS REQUESTED AND APPROVED, NO SWIM LINE SHALL BE PLACED BEYOND THE POINT WHERE THE DEPTH OF WATER EXCEEDS 6 FEET OR FOR A DISTANCE FROM SHORE OF 50 FEET, WHICHEVER OCCURS FIRST.
SWIM LINES NOT PLACED IN ACCORDANCE WITH THE TERMS OF THE APPROVED PERMIT MAY BE REMOVED AND THE SWIM LINE PERMIT REVOKED
5. Please complete the following (check one): |
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a. Are you requesting a variance? |
Yes |
No |
b.If you are requesting a variance, please clearly state the reason(s) for this request. You must also descriptively state the water depth and distance from shore at the point where you are requesting that the swim line be located
4.Please provide a diagram / map which shows the following (The map must be accurate in relation to North):
a.Your shore line and property lines (indicate feet).
b.Proposed location of swim line and depth of water in feet.
c.Length of swim line.
d.Locations, dimensions and distance in feet of moorings, docks, boat houses, breakwaters located off your shore front.
e.The shore lines and property lines of your abutters in feet.
f.Locations, dimensions and distances (in feet) of swim lines, moorings, docks, and rafts located off your abutters water fronts.
g.Unsigned applications will be returned.
Signature of Applicant |
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DIAGRAM:
N
With an arrow, please indicate North
FOR OFFICIAL USE ONLY:
Applicant:
Body of Water:
1. Field investigation notes:
2.Approval status recommendation: Approve as submitted.
Approve with the same conditions as prior years:
Approve with the following conditions:
Deny: Please provide reason for recommendation of denial.
Signed: |
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Date: |