HomeMy WebLinkAbout182318 02/17/2010 Q CITY OF CARMEL, INDIANA VENDOR: 074600 Page 1 of 1
ONE CIVIC SQUARE DEPT OF NATURAL RESOURCES CHECK AMOUNT: $10.00
CARMEL, INDIANA 46032 DIVISION OF WATER
402 W WASHINGTON ST W254 CHECK NUMBER: 182318
INDIANAPOLIS IN 452D4
CHECK DATE: 2117/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4350400 PERMITS 10.00 GROUNDS MAINTENANCE
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APPLICATION FOR AQUATIC FOR OFFICE USE ONLY DEPARTMENT OF NATURAL RESOURCES
VEGETATION CONTROL PERMIT License No. Division of Fish and Wildlife
State Form 26727 (R4 2 -04) Commercial License Clerk
A roved State Board of Accounts 2004 Date Issued 402 West Washington Street, Room W273
Whole lake ❑Multiple Treatment Areas Indianapolis, IN 46204
Check type of permit Lake County
INSTRUCTIONS: Please print or type information FEE: $5.00
Applicant's Name Lake Assoc. Name
rmea Cla n
Rural Route or Street Phone Number
1 -4 I 1 E l I LEL S 3 t 1 5 1 -�1
City and State ZIP Code
Car I nl cpn
Certified Applicator (if applicable) Company or Inc. Name Certification Number
Rural Route or Street Phone Number
City and State ZIP Code
Lake (One application per lake) Nearest Town County
1 r P e -land 1 (4 mI(I+orj
Does water flow into a water supply Yes I� No
Please complete one section for EACH treatment area. Attach lake map showing treatment area and denote location of any water supply intake.
Treatment Area LAT /LONG or UTM's
Total acres to be
controlled 9 �j Proposed shoreline treatment length (ft) Perpendicular distance from shoreline (ft) aC>
Maximum Depth of
Treatment ft Ex ected dates) of treatments f"i 11 c; 1 0
Treatment method: ®Chemical OPhysical Biological Control Mechanical
Based on treatment method, describe chemical used, method of physical or mechanical control and disposal area, or the species and stocking
rate for biological control. p) S O` UiI OCl O� A U0.('L and
Plant survey method: Rake ®Visual ❑Other (specify)
Aquatic Plant Name Check if Target Relative Abundance
Species Rio of Community
1
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M I'd 4 7 i_I I Lf
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Page a of
Treatment Area C LAT/LONG or UTM's
Total acres to be
controlled Proposed shoreline treatment length (ft) j D Perpendicular distance from shoreline (ft) 5 0
Maximum Depth of
Treatment ft Expected date(s) of treatment(s) CD l7 t D
Treatment method: ®Chemical Physical Biological Control OMechanicai
Based on treatment method, describe chemical used, method of physical or mechanical control and disposal area, or the species and stocking
rate for biological control. C) O O O�LT�'1 O 1(ilu_ r Y
Plant survey method: Rake visual Other (specify)
Aquatic Plant Name Check if Target Relative Abundance
Species of Communi
o
INSTRUCTIONS: Applicant must sign the application and is the only signature required. If applicant is also a certified chemical applicator, sign the "certified
applicator" signature box
Applicant Siq tur Date
1 to
Certified Applicator's Signature Date
FOR OFFICE ONLY
Fisheries Staff Specialist
Approved E] Disapproved
Environmental Staff Specialist
Approved El Disapproved
Mail check or money order in the amount of $5.00 to:
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF FISH AND WILDLIFE
COMMERCIAL LICENSE CLERK
402 WEST WASHINGTON STREET ROOM W273
INDIANAPOLIS, IN 46204
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APPLICATION FOR AQUATIC FOR OFFICE USE ONLY DEPARTMENT OF NATURAL RESOURCES
VEGETATION CONTROL PERMIT License No. Division of Fish and Wildlife
State Form 26727 (R4 2 -04) Commercial License Clerk
f AWroved State Board of Accounts 2004 Date Issued 402 West Washington Street, Room W273
Whole take Multiple Treatment Areas Indianapolis, IN 46204
Check type of permit Lake County
INSTRUCTIONS: Please print or type information FEE: $5.00
Applicant's Name Lake Assoc. Name
IXM rI1,S
Rural Route or Street Phone Number
l4l1 E ?,I 7_
City and State ZIP Code
r l I�1 (pb
Certified Applicator (if applicable) Company or Inc. Name Certification Number
Rural Route or Street Phone Number
City and State ZIP Code
Lake (One applica nn per lake) Nearest Town County
r llv, ca y rn a m'\� +on
Does water flow into a water supply El Yes Fallo
Please complete one section for EACH treatment area. Attach lake map showing treatment area and denote location of any water supply intake.
T reatment Area LAT /LONG or UTM's
Total acres to be
controlled 5-
Proposed shoreline treatment length (ft) Qd 3a I Perpendicular distance from shoreline (ft) 1 (3
Maximum Depth of d
Treatment ft Expected date(s) of treatment(s) 1 0
Treatment method: Chemical E]Physica! Biological Control Mechanical
Based on treatment method, describe chemical used, method of physical or mechanical control and disposal area, I orr the species and stocking
C2
rate for biological control. D0 0, O Ot cf&V. j Ur n T
Plant survey method: Rake Visual Other (specify)
Aquatic Plant Name Check if Target Relative Abundance
Species %of Community
Page d of 3
Treatment Area L T /LONG or UTM's
Total acres to be
controlled Proposed shoreline treatment length (ft) Perpendicular distance from shoreline (ft)
Maximum Depth of
Treatment (tt) Expected date(s) of treatment
Treatment method: Chemical Physical Biological Control Mechanical
Based on treatment method, describe chemical used, method of physical or mechanical control and disposal area, or the species and stocking
rate for biological control.
Plant survey method: Rake Visual Other (specify)
Aquatic Plant Name Check if Target Relative Abundance
Species of Community
INSTRUCTIONS: Applicant must sign the application and is the only signature required. If applicant is also a certified chemical applicator, sign the "certified
applicator" signature box
Applican�re at Date
Certified Applicator's Signature Date
FOR OFFICE ONLY
Fisheries Staff Specialist
Approved Disapproved
Environmental Staff Specialist
Approved Disapproved
Mail check or money order in the amount of $5.00 to:
DEPARTMENT OF NATURAL RESOURCES
DIVISION OF FISH AND WILDLIFE
COMMERCIAL LICENSE CLERK
402 WEST WASHINGTON STREET ROOM W273
INDIANAPOLIS, IN 46204
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West Park
sS 2 001 0 k00' 200' 400'
!`,roraruction co W PAR scale I' 120'
November 11, 7001
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Department of Natural Resources Purchase Order No.
074600 Division of Fish and Wildlife Terms
Commercial License Clerk
402 West Washington St., Room W273
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
1126110 Permits Vegetation control permits 10.00
Total 10.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with tC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Department of Natural Resources
074600 Division of Fish and Wildlife Allowed 20
Commercial License Clerk
402 West Washington St., Room W273
Indianapolis, IN 46204 In Sum of
10.00
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1125 Permits 4350400 10.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
11 -Feb 2010
*1W n&tm
Signature
10.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund