Treatment sign-up form and amount due LOA membership and application for a permit to control aquatic plants. "*" indicates required fields Shoreline feet owned*Shoreline feet allowed for treatment*Please enter a number from 1 to 100.(“allowed” = up to 100′ or 50% of owned shoreline, whichever is less. e.g. own 80′, max allowed 40′. If your lot is less than 70′ you are allowed up to 35 feet of treatment.)HiddenShoreline feet requested to be treated*Please enter a number from 1 to 100.HiddenLakeside house color HiddenHouse description from lakesideHiddenTreatment area description / other comments & instructions(e.g. boat brand, type of dock, gazebo, etc)MN DNR – Application for Permit to Control Aquatic PlantsName* First Middle Last Cell Phone NumberHome Phone NumberLake Home Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code HiddenFire # / 911 # Permanent Mailing Address Same as Above Permanent Mailing Address Information Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address*(Enter the email address we should send future LOA communications to) HiddenSize of Area Proposed To Be Treated(For Admin Use Only)My property extends _____ ft along shore. Proposed treatment area extends _____ ft along shore by _____ ft lakeward, out to a depth of _____ ft and/or a channel _____ ft long and _____ ft in width extending to open water.Terms & ConditionsBy signing this form I hereby make application for a permit to destroy or control aquatic vegetation or aquatic nuisance as described above. I understand that the control of aquatic nuisances, including destruction of aquatic plants and algae, is subject to rules of the Commissioner of Natural Resources. I understand that an Aquatic Plant Management Specialist may wish to inspect the proposed treatment area before, during, and/or after work is completed and that by making this application I give permission to the specialist to enter my property to make such inspection at reasonable times. I understand that an annual report will be required on results achieved. Your signature on this form applies to both a fluridone treatment or a traditional treatment in the event the backup plan is exercised. Completion of this form and processing of the accompanying application fee does not constitute obtaining a permit.Applicant's Signature*Sign your name in this box using your mouse, trackpad, or touchscreen:Electronic Signature Consent*By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. I agree with the Terms and Conditions Date* MM slash DD slash YYYY Amount DueTotal includes “allowed” = up to 100′ or 50% of owned shoreline, whichever is less. e.g. own 80′, max allowed 40′. Cost would be 40′ x $5.00 = $200 + $250 onetime special assessment + $10 membership for $460 total.) If your lot is less than 70′ you are allowed up to 35 feet of treatment. Lakeshore Footage Price: $0.00 One-time Special Assessment* Price: * Without the special assessment a fluridone treatment will not be possible, enabling the EWM problem to grow worse.Membership Dues Price: Total CommentsThis field is for validation purposes and should be left unchanged. Δ
