Temporary Camp Plan Review Licking County Health Department

Licking County Health Department, 675 Price Road, Newark, OH 43055 (740)349-6475

Plans for a temporary park-camp shall be submitted to the licensor for review and approval at least fifteen (15) days prior to the opening of the temporary camp. The licensor may request additional information or return incomplete plans to the applicant.

Event Name:Click Here To Enter Text

Date of the Event -	From:	To:

Location:Click Here To Enter Text

Promoter/ Party Responsible: Click Here To Enter Text

Phone:	E-mail: Click Here To Enter Text

Camp Site Information

Number of Campsites Requested:

Total Number of Campsites (including existing licensed camp sites):

** Attach a sheet with the temporary camp site plan layout that includes the following:

The area and dimensions of the tract of land

Portable toilets (Portable toilets must be no more than 1000 ft. walking distance from camp sites.)

First Aid

Tent Sites (10 ft. minimum between tents)

RV Sites (15 ft. minimum between RV’s side-to-side, 10 ft. minimum from end-to-end)

Trash Storage

Lighting

Roadways and pathways

Parking

Fire Protection Fire Protection

Written verification obtained by the fire protection authority or authorities that have jurisdiction in the area of all of the following:

The park or camp has adequate protection.

The method and layout of the fire protection.

That applicable fire codes shall be adhered to in the construction and operation of the park or camp.

First Aid

Type of First Aid Supplied? : Click Here To Enter Text

Name of Company Providing Service:Click Here To Enter Text

Shower and Hand Washing Facilities

Will showers be available? Yes No

Will hand washing/sanitizing stations be available? Yes No

Name of Company Providing Service: Click Here To Enter Text

Service Provider’s Phone Number:

Sites	Men ( Urinals)	Men (Toilets)	Women (Toilets)
5 - 15	1	1
16 - 30	1	1	2
31 - 60	1	2	3
61 - 90	2	2	4
91 - 120	2	3	5
121 - 150	3	3	6
151 - 200	4	4	8
201 - 300	5	5	10
301 - 400	6	6	12
401 - 500	7	7	14
501 - Up	Add 1 per 200	Add 1 per 200	Add 2 per 200

Toilet Facilities Number of Portable Toilets:

(See the chart to the right.)

Name of Company Providing Service:

Click Here To Enter Text

Potable Water

Will potable water be provided? Yes No

Select Potable Water Option: Choose an item.

Name of Company Providing Service: Click Here To Enter Text

Service Provider’s Phone Number: Click Here To Enter Text

Solid Waste

Name of Company Providing Service: Click Here To Enter Text

Method of Storage: Click Here To Enter Text

Method of Trash Collection: Click Here To Enter Text

Number of Receptacles Provided: Click Here To Enter Text

Lighting

Is there sufficient lighting to provide illumination and visibility of all public service buildings?

Yes No, lighting will be provided by: Click Here To Enter Text

Animals and Pets

All pets permitted in the event must be registered prior to entry.

Registration shall include:

Owners Name

Owners Address

Owner’s Phone Number

Name of an Animal

Type/Breed

Event Rules

Are the event rules attached to the plan review? Yes No

Will the rules be conspicuously posted or provided to patrons? Yes No

04/2015 Signature of Applicant	Date