Fillable 2020 Clear Lake Aquatic Plant Management Permit Application (County of Lake)

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2020 Clear Lake Aquatic Plant Management Permit Application (County of Lake)

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BROWSE COUNTY OF LAKE (CA) FORMS

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2020 Clear Lake Aquatic Plant Management Permit Application
*NEW for 2020* Attached map must show outline of treatment area with calculated square footage for new permit fee*
Permit No. _________________ Hydrilla Management Area (1-80, C1-5)_________ Mechanical or Chemical
Received by:___________________________
Date: ____________/2020
Assessor’s Parcel
Number
(APN)
Purpose of
the 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
Coontail
Milfoil
ILPW
Curly
Primrose
Azolla
Ot
her
(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):________________
Owner: ________________________________________ Date: ____________/2020
Applicator: _________________________ Telephone: __________________ Fax: __________________
Pest Control Operator’s Bus. License No.: _________________ Applicator's Q.A.L. #: ____________
All Clear Lake herbicide 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 w
ill 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: ____________/2020
S
wim
Area
Signature: or
Agent of Owner(s): ________________________________________ Date: ____________/2020
Disposal Address & Description: ______________________________________________________________________________
_______________________________________________________________________________________________________
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.
Clear Lake Aquatic Plant
Management Permit Application 2020
page 2 of 2
Permit No. ___________________
*******************************************************************ENDORCEMENTS***********************************************************
Mechanical
Approved___ Denied ___
Chemical:
Approved___ Denied ____
California Dept. Food and Agriculture Hydrilla Program
______________________________________, ________/2020
Signature: Date
Management Area _____________
Active Hydrilla Treatment Area Y / N
Chemical:
Approved___ Denied____
County Agricultural Commissioner’s Office
______________________________________, ________/2020
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 the lake with the
harvested vegetation.
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: Except with respect to activ
e 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: ____________/2020
Application Final Approval - Fee Paid
Form of Payment:
**NEW Permit Fees** Herbicide: $0.01 per square foot, Mechanical/Physical: $47
W:\Aquatic Plant Management Program\Aquatic Weed-Admin\Forms\APM Application
Form 2020
Mechanical:
Approved___ Denied___
NOTES:
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
__________________________
Initial: ___________
Map Attached
Treatment Area Outlined
For herbicide permits only, Square
Footage Calculated to be: ___________________________ x $ = $ ______________________
Water R
esources Department Approval: __________________________________ Date: ____________/2020
Cash
Check Number: __________
Check
Total Fees Paid: __________
Receipt No: ______________
Pick Up Date: ____________/2020
0
0.01
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2020 Clear Lake Aquatic Plant Management Permit Application (County of Lake)

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Completed 6 August 2020

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