Name:

Employee ID:

Phone:

Agency:

Your e-mail:

Who approves parking permits for your department?

What is their e-mail address?

Service Type (vendors only):

Other Info (limit your description to two lines please):

Make:

Color:

Model:

License Plate:

Vehicle Year:

Old Permit Number:

First Request

Renewal

County Vehicle:

Yes

No

Where would you like to park?

Multiple Lots / Other:

Start Date

End Date

(Note: Temporary parking is for official business only)

State Reason for temporary request (if applicable):

Why do you need to park there?

Note: Your reasons for parking will determine the amount of time you are permitted. With adequate reason, your time may be
extended. Parking without a current parking permit may result in a citation.

Where would you like to park?

Multiple Lots / Other:

General Parking Permit Application

Phone: (805) 477-1554

DS Collection

PMT NO

PERMIT HOLDER INFORMATION

A phone number where the permit
holder can be reached is required.

VEHICLE INFORMATION

LOT INFORMATION

800 South Victoria, Ventura Campus

Off Campus Sites

Start Date

End Date

Temporary:

Temporary:

(Note: Temporary parking is for official business only)

State Reason for temporary request (if applicable):

Why do you need to park there?

GSAPPA (Rev. 03/18/2016)

Submission Date: