EQP 2749 (Rev. 02/06) AQ 

### Michigan Department of Environmental Quality

Water Bureau



# EXPEDITED APPLICATION FOR PERMIT TO CONTROL

NUISANCE AQUATIC PLANT AND/OR ALGAE GROWTH

THIS APPLICATION IS TO BE USED ONLY WHEN REQUESTED TREATMENT AREAS, CHEMICALS, AND CHEMICAL AMOUNTS ARE

IDENTICAL TO THOSE PERMITTED FROM AN INITIAL PERMIT APPL ICATION (FORM EQP 2790). UP TO FOUR CONSECUTIVE EXPEDITED

PERMIT APPLICATIONS MAY BE SUBMITTED FOLLOWING THE ISSUANCE OF THE INITIAL PERMIT.

Pursuant to Part 31, Water Resources Protection, of the Natura l Resources and Environmental Protection Act, 1994 PA 451, as ame nded (NREPA), and Part 33, Aquatic Nuisance Control, of the

NREPA, applicati on is made by the undersigned for a permit to chemically treat the waters described below for the control of nu isance aquatic plant and/or algae growth.

WATERBODY NAME (IF CANAL/MARINA, AL SO LIST NAME OF CANAL/MARINA) INITIAL PERMIT NUMBER



## – 

## 98

– – 

## 0

APPLICANT INFORMATION 

## * LOCAL PERSON RESPONSIBLE FOR TREATMENT (IF DIFFERENT)

NAME NAME

MAILING ADDRESS MAILING ADDRESS

CITY, STATE, ZIP CODE CITY, STATE, ZIP CODE

TELEPHONE (DAYTIME) FACSIMILE TELEPHONE (DAYTIME) FACSIMILE



## * If applicant is not the property owner , attach a letter or contract demons trating authorization for treatment.

I certify that the information provided is, to the best of my knowledge, correct. It is understood that a permit, if granted, can be revoked by

the MDEQ, as specified in R 323.3109 promul gated pursuant to Part 33 of Act 451 of 1994, as amended. If a permit is granted, I agree to

use materials strictly in accordance with label and permit re quirements, take full responsibility for planning and carrying out the permitted

treatment, and agree to indemnify and save ha rmless the State of Michigan against any and all actions, claims, briefs, demands, damages,

costs, loss, and expenses in any manner result ing from or arising out of the permitted treatment. I agree to submit the post-tr eatment data

required. I HEREBY CERTIFY THAT THE PROPERTIES TO BE TREATED ARE EITHER UNDER MY LEGAL CONTROL AND/OR

UNDER THE LEGAL CONTROL OF PARTIES WHO HAVE GRANTED ME PERMISSION TO APPLY PEST ICIDES, OR I REPRESENT A

UNIT OF GOVERNMENT WITH AUTHORITY TO APPLY PESTICIDES. I ACCEPT RESPONSIBILITY FOR THE PERMIT THAT MAY

BE ISSUED PURSUANT TO THIS APPLICATION AND UNDERS TAND THAT VIOLATIONS ARE SUBJECT TO PENALTIES UNDER

PART 33 OF ACT 451 OF 1994, AS AMENDED INCLUDING IM PRISONMENT AND FINES UP TO $25,000.



## Prior to carrying out the permitted chemical treatment, I will have obtained written permission from all of the property

owners within the treatment area, for the chem ical treatment of their bottomland property.

Yes (including property owner treating own property) No - check basis for authority:

Statutory Lake Board

Township/Special Assessment District

Applicant Signature: Name (print): Date:



## Fees are based on the size of the proposed treatment area. ALL FEES ARE NON-REFUNDABLE. Check appropriate box:

For treatment of areas less than 1⁄2 acre, the required fee is $75.00.

For treatment of areas of 1⁄2 acre or more but less than 5 acres, t he required fee is $200.00.

For treatment of areas of 5 acres or more but less than 20 acres, t he required fee is $400.00.

For treatment of areas of 20 acres or more but less than 100 acres, t he required fee is $800.00.

For treatment of areas of 100 acres or more, the required fee is $1,500.00.

Payment must be made in full or your application will be returned. Checks should be payable to: STATE OF MICHIGAN . Submit your check, the

completed application form, a list of fi ve riparians knowledgeable about the proposed treatment, including their name(s), addre ss(es), and telephone

number(s), and current authorization letter or contract to:

MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY

CASHIER’S OFFICE – WB – AQ

P.O. BOX 30657

LANSING, MICHIGAN 48909-8157 FOR CASHIER'S USE ONLY: 37000-40509-9037-481003-00