Triploid Grass Carp Pond Owner Stocking Permit Application

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APPLICATION FOR TRIPLOID GRASS CARP POND OWNER STOCKING PERMIT.

A brief description of the form or Application to be filled out here.

Vessel Name
Vessel Use / Endorsement
- Pleasure
- Commercial
Official Number
Confirm Official Number
Contact Information
Name
First Last
Email*
Enter Email Confirm Email
Phone*
A. Applicant Information (if completing on behalf of a corporation, association or club, that entity is the applicant)
1. Name of Applicant (owner or lessee):
2. Daytime Telephone:
3. Home Telephone:
4. Mailing Address
Street Address City State / Province / Region ZIP / Postal Code Country
B. Water Body Location and Description
5. Name of Water Body:
Type of pond/lake
- Natural
- Man-made
Location: County (name)
Municipality (name):
- City
- Borough
- Township
7. Is the applicant the owner or lessee of all the land on which this water body is located?
- Yes
- No
8. Surface area of lake or pond:
acres
Maximum depth:
feet
Average depth:
feet
9. Is your pond or lake created by a dam that is regulated by DEP? See instructions for Item 9.
- Yes
- No
If yes, what is the DEP ID No.
D - __________
10. Water source (check one):
- Runoff
- Well
- Spring
- Stream
- Other
Stream name
If other, specify
Outlet Type:
- None
- Spillway
- Standpipe
11. Name of the nearest water body that would receive water flowing from your lake or pond. (If unnamed, enter “unnamed tributary to name of Creek”):
12. Principal water body uses (Check any and all that apply):
- Fishing
- Swimming
- Boating
- Aquaculture
- Water Source
- Irrigation
If other, specify
13. Have grass carp been stocked in this water body in the past?
- Yes
- No
If yes, provide the following information, if known.
Permit # Year # carp remaining
14. Describe the measures or devices that will be used to prevent the escape of triploid grass carp. If the pond/lake is created by a regulated dam, approval of the device by DEP is required BEFORE dam installation.
Required - Attach a picture of the installed device on spillway or standpipe that will prevent grass carp escape. This application will not be considered unless a detailed description and picture of device are included.
15. *Required* -- Attach a map and directions from a named or numbered road, OR provide a latitude & longitude so we can locate your water body.
C. Aquatic Vegetation Information
16. Choose what type (s) of vegetation is problematic:
- Rooter and growing above the water
- Moss or pond scum (filamentous algae)
- Rooted and growing under the water
- Floating
- Other
If other, describe
Total surface area covered with problematic vegetation (check one):
- 10-25%
- 25-60%
- >61%
17.
Please type an "X" for what the density levels are.
Plant Species Density: High Density: Med Density: Low
18. Describe other methods of aquatic plant or algae control employed in the past:
D. Applicant Certification
19. The applicant: (a) understands that the Fish and Boat Commission makes no representation to the effectiveness of Triploid Grass Carp in any particular situation and that the applicant is responsible for consequences of such use, (b) understands that if a permit is issued, the permittee must obtain triploid (sterile) grass carp from a PFBC approved source of supply, and(c) certifies the truth of the above statements.
Name
Title (if applicable)
Application Fee
Price:
RENEWAL ADVANCED PAYMENT OPTION
- No Additional Years
- 2 year renewal +$75.00
- 3 year renewal +$150.00
- 4 year renewal +$225.00
- 5 year renewal +$300.00
Total
$285.00
Consent*
I CERTIFY THAT THE RECITATIONS CONCERNING THE VESSEL: NAME, TONNAGE, DIMENSIONS, PROPULSION, OWNERSHIP, HAILING PORT, RESTRICTIONS, ENTITLEMENTS, REMARKS AND ENDORSEMENTS CONTAINED IN THE CERTIFICATE OF DOCUMENTATION REMAIN ABSOLUTELY THE SAME.
I agree
NAME:*
Type your full name to sign this secure webform
Signature*
CAPACITY OF PERSON SIGNING (E.G., OWNER, AGENT, TRUSTEE, GENERAL PARTNER, CORPORATE OFFICER, MEMBER)
Date
MM slash DD slash YYYY
Authorization*
I agree to pay the above total amount according to the card issuer agreement and hereby authorize the charge for the total amount above for the processing of selected permits. I understand that my application will be processed in the order in which it is received by Commercial Fishing Permits Center, a private fee-for-service documentation company, not owned or operated by any governmental agency. I understand that application and processing fees are non-refundable as per Commercial Fishing Permits Center's no refund policy. I understand that submitting another application for a license or permit will supersede the current/pending application for that license or permit. I understand that Commercial Fishing Permits Center does not issue or sell any licenses or permits.
I agree
Credit Card
Card Details
Cardholder Name
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BILLING ADDRESS
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
By clicking submit you agree to these Terms and Conditions and the above authorization of payment.

Plant Species	Density: High	Density: Med	Density: Low

Contact Information

A. Applicant Information (if completing on behalf of a corporation, association or club, that entity is the applicant)

B. Water Body Location and Description

C. Aquatic Vegetation Information

D. Applicant Certification