Fillable 2019 Clear Lake Aquatic Plant Management Permit Application (County of Lake)

Fill Online, Printable, Fillable, Blank 2019 Clear Lake Aquatic Plant Management Permit Application (County of Lake) Form

Use Fill to complete blank online COUNTY OF LAKE (CA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

2019 Clear Lake Aquatic Plant Management Permit Application (County of Lake)

On average this form takes 27 minutes to complete

The 2019 Clear Lake Aquatic Plant Management Permit Application (County of Lake) form is 2 pages long and contains:

  • 0 signatures
  • 74 check-boxes
  • 74 other fields

Country of origin: US
File type: PDF

U.S.A. forms for County of Lake

BROWSE COUNTY OF LAKE (CA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
2019 Clear Lake Aquatic Plant Management Permit Application
Permit No. _________________, Hydrilla Management Area (1-80, C1-5)_________, Mechanical
or Chemical
**NEW for 2019** Attached map must show outline of treatment area with calculated square footage for new permit fee**
Received by:___________________________ Date: ________ /________/2019
Assessor’s Parcel
Number
(APN)
Purpose
of plant
Mgmt*
(See
Below)
Area of Plant
Management
(provide the square feet)
Plant & Management Type
(Check the boxes that apply)
APN :
_____________________
Owner (Last Name):
_______
______________
_____________________
Address(s):
_______________
______
_____________________
_____________________
_____________________
Boat
Dock
Access
Glyphosate
Diquat
Endothall
Triclopyr
2,4D
Flumioxazn
M
echanical*
Sago
Milfoil
Curly
Primrose
Azolla
Swim
Area
Other
(specify)
Total Area
* 1. Public Facility Safety, 2.Private Resort Safety, 3. Private Residence Safety, 4. Other (specify) ________
Mechanical
** a. Boat-Mounted Harvester b. Hand Pulling and Bagging c. Manual Cutter d. Other (explain):________________
Disposal Location _____________________________________________________________________________________
Owner _________________________________ Telephone:_____________________ Fax:__________________________
Contractor _______________________________ Telephone:_____________________Fax:__________________________
I
certify that I am the owner or have permission from owner to engage in aquatic plants control activity from the owner of the
parcel(s)
named on this application. I am familiar with the Clear Lake hitch status as a potentially endangered species and will,
prior to harvesting, disturb the water such that fish will vacate the treatment area and report any take of hitch.
Owner: __________________________________________________
Date: __________/__________/2019
Signature: or
Agent of Owner(s): _________________________________________ Date:
/
Herbicide
Applicator Telephone:
Pest Control Operator’s Bus. License #
Fax: ________________________
Applicator’s Q.A.L. #
All Clear Lake herbici
de applications will be made by a Qualified Licensed Applicator under the written recommendations of a
licensed Pest Control Advisor, and must comply with all applicable pesticide laws and regulations for California. I certify that I
have obtained permission to engage in weed control activity from the owner of the parcel named on this application. I hereby
certify that I will visit the site declared on this application to verify the need for treatment and the suitability of the site for treatment.
I agree to use only appropriate herbicides from the approved list according to label specifications. I will notify nearby users of lake
water, for drinking and irrigation uses, according to label directions.
Signature: _________________________________________________________________Date: /
/20
19
/2019
_______
Clear Lake Aquatic Plant
Management Permit Application 2019
page 2 of 2
Permit No. ___________________
*******************************************************************ENDORCEMENTS***********************************************************
Mechanical
Approved___ Denied ___
Chemical:
Approved___ Denied ____
California Dept. Food and Agriculture Hydrilla Program
______________________________________,
____/____/2019
Signature: Date
Management Area _____________
Active Hydrilla Treatment Area Y / N
Chemical:
Approved___ Denied____
County Agricultural Commissioner’s Office
______________________________________, ____/____/2019
Signature: Date
*************************************************************CONDITIONS OF PERMIT*******************************************************
In order to keep invasive species out of Clear Lake:
Watercraft returning here from out-of-county shall be screened for invasive mussels prior to each launch in Clear Lake or
any other water body in Lake County. All vessels shall be issued with resident or visitor stickers, whichever is appropriate.
Mechanical
1. Collection of fragmented material is
required.
2. Disposal of plants shall be
landward of high water.
3. Fragments must be prevented from
re-entry into any water body.
4. Any mechanical harvesting of
aquatic weeds must make every
attempt to
scare fish from the
treatment area so that there is no
likelihood of hitch being removed
(taken) from t
he lake with the
harvested vegetation.
Herbicide
1. Only approved herbicides are to be applied in accordance with NPDES Permit,
including 2,4-D, copper, diquat, endothall, glyphosate, flumoxazin, Sodium Carbonate
Peroxyhydrate, and triclopyr.
2. Submit a completed Supplemental Pesticide Use Report (SPUR) for each permit
number within 30 days of treatment.
3. Submit a completed Monthly Pre Application Species Abundance (PASA) Form
(Formerly the Monthly Aquatic Plant ID and Percentage Density Report) for each permit
within 30 days of treatment.
4. Applicator will provide work schedule 1 week prior to treatment to the Water
Resources Invasive Species Coordinator Angela.depalma-dow@lakecountyca.gov, 707-263-2344.
5. Application is permitted only when:
a. D.O. is greater than 5 ppm. (Must apply for exception)
b. Water temperature is lower than 80°F
c. Water is judged clear with low turbidity
d. Weather is calm (wind speed less than 10 mph)
e. No rain predicted.
HOLD HARMLESS: Ex
cept with respect to active negligence of a party indemnified herein, to the fullest extent permitted by law,
the permittee shall indemnify and hold harmless the COUNTY and its agents, officers and employees against and from any and all
claims, lawsuits, actions, liabilities, losses, damages, and expenses and costs (including but not limited to attorney’s fees) brought
for, or on account of, injuries to or death of any person or persons, including employees of permittee, or injuries to or destruction
of property, including the loss of use thereof, arising out of, or alleged to arise out of, or resulting from, the performance of the
work permitted herein, provided that any such claim, lawsuit, action, liability, damage, loss, expense, or cost is caused in whole or
in part by any negligent or intentional act or omission of permittee, or anyone directly or indirectly employed by permittee, or
anyone for whose acts permittee may be liable, regardless of whether or not it is caused by the passive negligence of a party
indemnified hereunder.
Applicant’s acceptance:______ ________________________________________
Date:_____/___________/2019
Application Final Approval - Fee Paid
Total Fees Paid __________ Check Number _________ Date: _____/_____/2019
Map Attached
Treatment Area Outlined **NEW Permit Fees** Herbicide: $0.01 per square foot, Mechanical/Physical: $47
County of Lake Dept. of Water Resources Signature: __________________________________ Date: _____/_____/2019
W:\Aquatic Plant Management Program\Aquatic Weed-Admin\APM Application Form 2019
Mechanical:
Approved___ Denied___
NOTES:
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
Initial: ______________________
For herbicide permits only, Square Footage Calculated to be: ___________________________ x $0.01 = $ .
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

2019 Clear Lake Aquatic Plant Management Permit Application (County of Lake)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 6 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document