Packet for Stocking of Triploid Grass Carp - Commercial Fishing Permits Center

Vessel Name

Vessel Use / Endorsement

Pleasure
Commercial

Official Number

Confirm Official Number

Contact Information

Name

First Last

Email*

Enter Email Confirm Email

Phone*

1. Name of Applicant or Organization

2. Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

3. Name of Lake or Pond to be Planted:

4.

County	Township	Range	Section

Note: A photocopy of a county map showing rivers and streams at the proposed planting location MUST be provided with this application.

5. Size of lake or pond (1 acre= 208 X 208 ft.)

Max Depth (ft)

6. Does this pond or lake have public access provided by the city, county, state or federal government or other publicly owned municipality?

(Answer “NO” for golf course, sewage treatment or fish culture ponds and power or irrigation canals). If you answered “NO”, go to #8

Yes
No

7. If you answered “YES” to number 6, are the results of a Lake Restoration Feasibility Study included?

If you answered “YES” go to # 10 and skip #11. If you answered “NO”, a permit cannot be issued until the standards for a lake restoration study have been met. Please contact your local WDFW regional office to proceed with this study.

Yes
No

8. Total number of waterfront property owners:

9. Number of waterfront property owners that support and oppose the proposed planting of triploid grass carp.

Note: The names, addresses and phone numbers of all waterfront property owners and whether or not they support the proposed grass carp introduction MUST be provided with this application.

Support	Oppose

10. Have all outlets and/or inlets been screened?

If you answered “NO” you must apply for a Hydraulic Project Approval (HPA) before installing screens. The Department of Fish and Wildlife will not issue a permit to plant triploid grass carp into waters with unscreened outlets. If the proposed lake or pond is greater than 20 acres, other permits from the county of jurisdiction may be required to install screens. Please contact your Department of Fish and Wildlife Regional Office for additional direction on this requirement.

Yes
No

Name of Lake or Pond

FISH STOCKING APPLICATION/PERMIT

Permit#/Year

WDFW Aquatic Farm Registration # (for commercial aquaculture facilities only):

Species:

Number (fish or eggs):

Destination (name of facility/receiving waters):

Species	Section	Township	Range

Facility name:

Facility number:

Physical Address of facility

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address of facility

Street Address City State / Province / Region ZIP / Postal Code

WDFW Aquatic Farm Registration # (for commercial sources in Washington):

Environmental Checklist

A. Background

Name of proposed project if applicable:

Plant triploid (sterile) grass carp to control aquatic vegetation.

2. Name of applicant:

3. Address of applicant and contact person:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone number of applicant and contact person:

4. Date of checklist prepared:

6. Proposed timing or schedule (include phasing, if applicable):

7. Do you have any plans for future additions, expansions or further activity related to or connected with this proposal? If yes, explain: YES, may need to restock, in five years or more, due to predation or natural die off.

8. List any environmental information you know about that has been prepared or will be prepared, directly related to this proposal:

9. Do you know whether applications are pending for government approvals of other proposals directly affecting the property covered by your proposal? If yes, explain: No.

10. List any government approvals or permits that will be needed for your proposal, if known:

a. Planting permit from Washington Department of Fish and Wildlife. b. Certificate from U.S. Fish and Wildlife Service that the fish shipped are triploids (sterile) and certification that the fish show no sign of disease.

11. Give a brief, complete description of your proposal, including the proposed use and the size of the project. There are several questions later in this checklist that ask you to describe certain aspects of your proposal. You do not need to answer those on this page.

a. Plant triploid grass carp to control aquatic vegetation.

12. Location of proposal. Give sufficient information for a person to understand the precise location of your proposed project, including: street address, if any, and section, township and range (required). If a proposal would occur over a range of areas, provide the range or boundaries of the site(s). Provide a legal description and site plan, if reasonably available. A copy of a vicinity map or topographic map is required. While you should submit any plans required by the agency, you are not required to duplicate maps or detailed plans submitted with any permit applications related to this checklist.

B. Environmental Elements

1. Earth

a. General description of the site (circle one): Flat, rolling, hilly, steep slopes, mountainous, other:

b. What is the steepest slope on the site (approximate percent slope)?

c. What general types of soils are found on the site (for example: clay, sand, gravel, peat, muck)? If you know the classification of agricultural soils, specify them and not any prime farmland.

d. Are there surface indications or history of unstable soils in the immediate vicinity?If so, describe:

e. Describe the purpose, type and approximate quantities of any filling or grading proposed. Indicate source of fill.

f. Could erosion occur as a result of clearing, construction or use? If so, generally describe:

g. About what percent of the site will be covered with impervious surfaces after project construction (for example: asphalt or buildings)?

h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:

2. Air

What type of emissions to the air would result from the proposal (for example: dust automobile, odors, industrial wood smoke) during construction and when the project is completed? If any, generally describe and give approximate quantities if known.

b. Are there any off-site sources of emissions or odor that may affect your proposal? If so, generally describe:

c. Proposed measures to reduce or control emissions or other impacts to air, if any:

3. Water

3. a) Surface

1. Is there any surface water body on the immediate vicinity of the site (including year-round and season streams, saltwater, lakes, ponds or wetlands)? If yes, describe type and provide names. If appropriate, state what stream or river it flows into.

2. Will the project require any work over, in or adjacent to (within 200 feet) the described waters? If yes, please describe and attach available plans.

3. Estimate the amount of fill and dredge material that would be placed in or removed from surface water or wetlands and indicate the area of the site that would be affected. Indicate the source of fill material.

4. Will the proposal require surface water withdrawals or diversions? Give general description, purpose and approximate quantities if known.

5. Does the proposal lie within a 100-year floodplain? general description, purpose and approximate quantities if known.

6. Does the proposal involve any discharges of waste material to surface waters? If so, describe the type of waste and anticipated volume of discharge.

3. b) Ground

1. Will ground water be withdrawn or will water be discharged to ground water? Give general description, purpose and approximate quantities, if known.

2. Describe waste material that will be discharged into the ground from septic tanks or other sources, if any (for example: domestic sewage, industrial, containing the following chemicals, agricultural). Describe the general size of the system, the number of such systems, the number of houses to be served (if applicable) or the number of animals or humans the system(s) are expected to serve.

3. c. Water Runoff (including storm water):

1. Describe the source of runoff (including storm water) and method of collection and disposal, if any (including quantities, if known). Where will this water flow? Will this water flow into other waters? If so, describe.

2. Could waste materials enter ground or surface waters? If so, generally describe.

3. Proposed measures to reduce or control surface, ground and runoff water impacts, if any:

4. Plants

a. Check or circle types of vegetation found on the site:

deciduous tree: alder, maple, aspen, other
evergreen tree: fir, cedar, pine, other
shrubs
grass
pasture
crop or grain
wet soil plants: cattail, buttercup, bulrush, skunk cabbage, other
water plants: water lily, eelgrass, milfoil, other
other types of vegetation

b. What kind and amount of vegetation will be removed or altered?

c. List threatened and endangered species (of plants) known to be on or near the site.

d. Proposed landscaping, use of native plants or other measures to preserve or enhance vegetation on the site if any:

5. Animals

Check birds that have been observed on or near the site or are known to be on or near the site:

Hawk
Heron
Eagle
Songbirds
Other

Other

Check Mammals that have been observed on or near the site or are known to be on or near the site:

Deer
Bear
Elk
Beaver
Other

Other

Check Fish that have been observed on or near the site or are known to be on or near the site:

Bass
Salmon
Trout
Herring
Shellfish
Other

Other

b. List any threatened or endangered species known to be on or near the site.

c. Is the site part of a migration route? If so, explain.

d. Proposed measures to preserve and enhance wildlife, if any:

6. ENERGY AND NATURAL RESOURCES

a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used in order to meet the completed project’s energy needs? Describe whether it will be used for heating, manufacturing, etc.

b. Would your project affect the potential use of solar energy by adjacent properties? If so, generally describe.

What kinds of energy conservation features are included in the plans of this proposal? List other proposed measures to reduce or control energy impacts, if any:

7. ENVIRONMENTAL HEALTH

a. Are there any environmental health hazards, including exposure to toxic chemicals, risk of fire and explosion, spill or hazardous waste that could occur as a result of this proposal.

1. Describe special emergency services that might be required.

2. Proposed measures to reduce or control environmental health hazards.

b. Noise 1. What types of noise exist in the area that may affect your project (for example: traffic, equipment, operation, other)?

2. What types and levels of noise would be created by or associated with the project on a short-term or long-term basis (for example: traffic, construction, operation, other)? Indicate what hours noise would come from the site.

3. Proposed measures to reduce or control noise impacts, if any:

8. LAND AND SHORELINE USE

1. What is the current use of the site and adjacent properties?

2. Has the site been used for agriculture? If so, describe?

3. Describe any structures on the site.

4. Will any structures be demolished? If so, what?

5. What is the current zoning classification of the site?

6. What is the current comprehensive plan designation of the site?

7. If applicable, what is the current shoreline master program designation of the site?

8. Has any part of the site been classified as an “environmentally sensitive” area? If so, specify.

9. Approximately how many people, would reside or work in the completed project?

10. Approximately how many people would the completed project displace?

11. Proposed measures to avoid or reduce displacement impacts, if any:

12. Proposed measures to avoid or reduce displacement impacts, if any:

9. Housing

1. Approximately how many units would be provided, if any? Indicate whether high, middle or low-income housing.

2. Approximately how many units, if any would be eliminated? Indicate high, middle or low-income housing.

3. Proposed measures to reduce or control housing impacts, if any:

10. AESTHETICS

1. What is the tallest height of any proposed structure(s), not including antennas; what is the principal exterior building material(s) proposed?

2. What views in the immediate vicinity would be altered or obstructed?

3. Proposed measures to reduce or control aesthetic impacts, if any:

11. LIGHT AND GLARE

1. What type of light or glare will the proposal produce? That time of day would it mainly occur?

2. Could light or glare from the finished project be a safety hazard or interfere with views?

3. What existing off-site sources of light or glare may affect your proposal?

4. Proposed measures to reduce or control light and glare impacts, if any:

12. RECREATION

1. What designated and informal recreational opportunities are in the immediate vicinity?

2. Would the proposed project displace any existing recreational uses? If so, describe.

3. Proposed measures to reduce or control impacts on recreation, including recreational opportunities to be provided by the project or applicant, if any:

13. HISTORIC AND CULTURAL PRESERVATION

1. Are there places or objects listed on, or proposed for, national, state or local preservation registers known to be on or next to the site? If so, generally describe.

Generally describe any landmarks or evidence of historic, archaeological, scientific or cultural importance known to be on or next to the site.

14. TRANSPORTATION

1. Identify public streets and highways serving the site, and describe proposed access to the existing street system. Show on site plans, if any.

2. Is the site currently served by public transit? If no, what is the approximate distance to the nearest transit stop?

3. How many parking spaces would the completed project have?

4. How many would the project eliminate?

5. Will the proposal require any new roads or streets, or improvements to existing roads or streets, not including driveways? If so, generally describe (indicate whether public or private).

6. Will the project use (or occur in the immediate vicinity of) water, rail or air transportation? If so, generally describe.

7. How many vehicular trips per day would be generated by the completed project? If known, indicate when peak volumes would occur

8. Proposed measures to reduce or control transportation impacts, if any:

15. PUBLIC SERVICES

1. Would the project result in an increased need for public services (for example: fire protection, police protection, health care, schools, other)? If so, generally describe.

2. Proposed measures to reduce or control direct impacts on public services.

16. UTILITIES

1. Check utilities currently available at the site

electricity
natural gas
water
refuse service
telephone
sanitary sewer
septic system

Other

2. Describe the utilities that are proposed for the project, the utility providing the service and the general construction activities on the site or in the immediate vicinity that might be needed.

Application Fee

Price:

RENEWAL ADVANCED PAYMENT OPTION

No Additional Years
2 year renewal
3 year renewal
4 year renewal
5 year renewal

Total

$0.00

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

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

Having Trouble with your card?

Check this box to move forward without your Credit Card.

My card information is not working

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.