SABINE RIVER AUTHORITY PRIVATE USE PERMIT APPLICATION
STATE OF LOUISIANA
15091 TEXAS HWY. APPLICATION NO.______
MANY, LA 71449-5718 PAID/CHECK #______
(318) 256-4112 RECEIPT # ______
1. Applicant ______Home Phone:______
Mailing ______Daytime Phone:______
Address ______Other Phone:______
2. (a) Physical Address (if none) legal description of lakeside property:______
______Section______Township______Range______
(b) Name of Subdivision______Blk______Lot No.______
3. (a) Check one: Applicant______owns, or ______leases the land referred to in item 2
(b) Is leaseback area included in deed or lease:_____yes______no
4. Type of structure/s to be placed on leaseback property :______
______
Attach a dated and signed site drawing of the shoreline and property lines showing the placement and dimensions of proposed structure or structures.
5. Attach a copy of your deed including leaseback assignment, and/or lease agreement.
* Applications will not be accepted unless the items listed in 4 and 5 above are included with application.
Applicant agrees to abide by the rules and regulations of the Sabine River Authority, as well as State, Parish, and Federal laws that are applicable to the Toledo Bend area.
The following applicable fees are payable to the SRA of LA.:
An inspection fee of $ 35.00 for each permit application (All permits remain pending until all required documents are provided, the project is completed, and a final inspection has been requested and approved. Permits may remain pending for 18 months before expiration. Existing structures, transfers, and current projects may be included in one permit. At the end of the pending period, a final inspection will be performed and the permit closed, providing that all documents are provided and the completed improvements pass final inspection. Fees on all private structures and shoreline improvements are payable one time upon application for said permit; and shall be valid so long as said structure meets reasonable requirements of structural soundness, endurance, and appearance. Additional private use permit information is available by request from the Shoreline Department.
A Permit transfer fee of $ 35.00 is required for ownership changes.
Water withdrawal - an annual fee of $ 50.00 (no tax) to mechanically remove or pump un-metered lake water.
The Authority does not take responsibility for protecting the applicant’s property nor guarantee that said property will not be used by other persons in the absence of applicant. It being expressly intended that the Authority assumes no responsibility for the conduct of activities herein permitted which shall be at the sole risk of the applicant. Applicant
agrees that in the event any lawsuit or claim is filed, for any reason, naming the SRA, arising out of the issuance of this permit, that Permitee agrees to hold harmless, defend, and indemnify the SRA.
I certify that the above information is true and correct to the best of my knowledge.
______Date ______
Signature of Applicant
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Final Inspection and Permit Approved
______By: ______
Date
Title:______
Revised 5-06