178114 10/14/2009 (9) CITY OF CARMEL, INDIANA VENDOR: 074600 Page 1 of 1
ONE CIVIC SQUARE DEPT.OF NATURAL RESOURCES CHECK AMOUNT: $10.00
CARMEL, INDIANA 46032 DIV OF FISHlWILDLIFE -COMM LIC. CLR
402 W. WASHINGTON ST., ROOM W273 CHECK NUMBER: 178114
INDIANAPOLIS IN 46204
CHECK DATE: 10/1412009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4350400 PERMITS 10.00 GROUNDS.MAINTENANCE
Carmel a Clair
Parks &Recreation CHECK REQUEST
Date: 9128109
c r-� r
Check payable to
s E N
Name: Department of Natural Resources e-' 2009
Division of Fish and Wildlife
Commercial License Clerk
Address: 402 West Washington St Room W273
City, State, Zip Indianapoils, IN 46204
x Mail check to payee Return check to requestor
Check Amount 10.00 Date Reguired T _658P
Check needed for vegetation control permits
Supporting documentation or receipt(s) MUST be attached.
To be paid from
Po N A
Budget account GL 1125- 430 100 4350400 ($5.00)
1125 -430- 105 4350400 ($5.00)
Budget Line Description grounds maintenance
Requested by (print): Serra Garske
Requested by (signature).
Approved by (signature of Division Manager
on this date 6
Form revised 1 -21 -08
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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
Approved 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
Rural Route or Street Phone Number
City and State ZIP Coq
V.
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
Does water flow into a water supply Yes 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 fl 7T/LONG or UTM's E-
Total acres to be
controlled 5 Proposed shoreline treatment length (ft) 1� 05 1 Perpendicular distance from shoreline (it) Q`
Maximum Depth of
Treatment it (,p Expected dale(s) of treatment(s) S O r at7
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. 1 LD 0'L i rk- W (On Qr
Plant survey method: Rake Visual Other (specify)
Aquatic Plant Name Check if Target Relative Abundance
Species of Community
JIL
Page --g9 of 3
Treatment Area LAT /LONG or UTM's
Total acres to be
controlled Pro sed shoreline treatment length (ft) Perpendicular distance from shoreline (ft)
Maximum Depth of
Treatment it Expected date(s) of treatment(s)
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: E]Rake E]Visuai 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
Applicant n ure Date q
Certified Applicator's Signature Date
FOR OFFICE ONLY
Fisheries Staff Specialist
Approved Disapproved
Environmental Staff Specialist
D Approved 1:1 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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November 21, 2 001
Return to: Page 1 of
APPLICATION FOR AQUATIC FOR OFFICE USE ONLY DEPARTMENT OF NATURAL RESOURCES
VEGETATION CONTROL PERMIT License No. Division of Fish and Wildlife
State Form 26727 (134 12-04) Commercial License Clerk
A roved 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:
Applicant's Name Lake Assoc. Name
�>cktA�rs NG LA E-1_ L LAY P R K 4 Ra
Rural Route or Street Phone Number
14 ii1 E. 1 STRE E-T S 1. i -AA
City and State ZIP Code
R IN 4 -Cna3Z
Certified Applicator (It 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
TPPSI.- U �n-Ac� L r 1__ 4 A M 1
Does water flow into a water supply Yes No
LeN
Please complete one section for EACH treatment area. Attach lake map showing treatment area and denote location of any water supply intake.
Treatment Area LA 1LLONG or UTM's
Total acres to be
controlled �J Proposed shoreline treatment length (ft) tP0 Pe endicular distance from shoreline (ft)
Maximum Depth of r
Treatment ft f;,p Expected date(s) of treatment(s)
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. R 0 UQ r o CAi"lU .O t 1711 e-
Plant survey method: Rake I Ul Visual Other (specify)
Aquatic Plant Name Check if Target Relative Abundance
Species of Community
J q Page of
7 Treatment Area or UTM's �R�F ER rb 1 N P
Total acres to be
controlled Proposed shoreline treatment length (ft) D�$ Perpendicular distance from shoreline (ft) 15. 6 bui 4A)
Maximum Depth of
Treatment (ft) J Expected date of treatment(s) C) D
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 l and stocking (r�
rate for biological control. OZ a 00 Q d Z e, KJcv- co 4 0 11 ons r
Plant survey method: Rake visual Other (specify)
Aquatic Plant Name Check if Target Relative Abundance
Species of Community
1, 5 /p
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 Si, toe Date
of o9
Certified licator's Signature Date
FOR OFFICE ONLY
Fisheries Staff Specialist
D Approved 1:1 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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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.
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
9/28109 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 IC 5- 11- 10 -1.6
20_
Clerk- Treasurer
Voucher No. Warrant No.
Department of Natural Resources
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. ALCCT #JTITLE 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
7 -Oct 2009
Signature
I 10.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund