DEPARTMENT OF LAND AND NATURAL RESOURCES - Hawaii



| |Division of State Parks, Department of Land and Natural Resources |Permit Number |

| |Vessel Special Use Permit - Commercial |(to be filled out by DSP staff) |

| |Kealakekua Bay State Historical Park (KBSHP) | |

| | |KBSHP- | |

| | |EXPIRATION: Dec. 31, 2019 |

| | |e / f / m:| |Ins: | |

|Note: Required Information marked with asterisk ( * ) – Blue numbers below correspond to those on the Page 2 instruction sheet. |

|1. Permit Status (click box)* |2. Permittee (owner or manager of business; name as shown on driver’s license or official identification) * |

|New Permit | | | | |

|Renewal | |First Name* |Middle Initial |Last Name* |

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|Commercial Kayak Permit Decal Tag Numbers |

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|All kayaks permitted to transit the waters of Kealakekua Bay State Historical Park under a commercial Vessel Special Use Permit shall have State Parks issued decals |

|affixed to both sides of their bows. |

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|Decals are issued to applicants when renewing their annual permits or applying for a permit the first time. The sequential tag numbers on the decals are issued in pairs|

|so that the assigned number can be affixed to each side of the kayak, one on the starboard side and the other on the port side. |

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|When the Vessel Special Use Permit is issued, tag number decals will be issued for every kayak covered by that permit. For example, when an applicant is issued permit |

|number 059 and that permit covers 10 kayaks, the applicant will receive 10 pairs of decals to affix to the kayaks (such as numbers 15 through 24). |

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|Be sure to clean the kayak surface thoroughly before applying the decals and squeegee the decals down firmly. If the decal does not adhere firmly to pebbled or highly |

|uneven kayak surface materials, attach a smooth surfaced placard to the kayak surface and affix the decals to the placards. Epoxy, adhesives, screws or rivets can be |

|used to hold placards in place. The placard can be reused in subsequent years. Should your decal become damaged or illegible, you may obtain a new one from our office.|

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|The following Tag Numbers are assigned to Vessel Special Use Permit: |

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|Assigned Kayak Tag Number |

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|Assigned Kayak Tag Number |

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|Assigned Kayak Tag Number |

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|I have reviewed, understand, and agree to affix the Tag Numbers to the commercial kayaks authorized under this Vessel Special Use Permit as described in the above |

|instructions. I acknowledge that as the permit holder, I am responsible to have decals easily visible, in good condition and on the approved kayaks at all times and |

|that not following these conditions may be grounds for the revocation of my permit. |

|Permittee Signature:* |/s/ | |Date:* | |

| | |(Please sign or type name above) | |(mm/dd/yyyy) |

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