Application for Permit

Permit History
YesNo
If yes, provide the number of the most recent permit or COC:
The proposed area of impact is the same or entirely contained within the area of impact approved in the previous permit.The active ingredient or trade name of each chemical proposed to be applied is the same as approved in the previous permit and each chemical is currently approved for use by the department.The application rate and number of treatments do not exceed those approved in the previous permit.The minimum length of time between treatments is not less than approved on the previous permit.The proposed treatment differs from the previous permit.

Treatment Information
The Michigan Department of Environment, Great Lakes, and Energy has issued a General Permit for each of the following:

(1) Aquatic Nuisance Control Activities for Ponds

(2) Aquatic Nuisance Control Activities Canals and Marinas Located on the Great Lakes and Connecting Waters

(3) Aquatic Nuisance Control Activities for Certain Non-native Invasive Emergent and Floating-Leaf Plants.

In order to have authorization to chemically treat waters of the state under a General Permit, a Certificate of Coverage (COC) must be issued by EGLE.

Please read the applicable General Permit and any amendment(s) thoroughly to ensure that your proposed treatment protocol is covered.

CLICK HERE to review the General Permits and Eligibility Lists
PondsCanals & Marinas Located on the Great Lakes and Connecting WatersCertain Non-native Invasive Emergent Plants
Total surface area proposed for treatment (in acres)*
One ace = 43,560 feet

Fill out the table below with all relevant information*

Rows	Chemical 1	Chemical 2	Chemical 3	Chemical 4	Chemical 5	Chemical 6	Chemical 7	Chemical 8	Chemical 9	Chemical 10
Name of Product or Chemical Proposed
Treatment Area Type
Target Plant(s) and/or Algae
Size of Treatment Area (acres)
Application rate (include units)
Total amount of chemical proposed (include units)
Approximate date(s) of application

What pesticide application business or individual will be applying chemicals?
YesNo
If yes, please provide the name of and contact information (i.e., phone number and email address) for the lake management consultant:

Treatment Map
Provide a proposed treatment map(s) showing an accurate representation of the waterbody shape.

Treatment map must include the following (if applicable):

1. Treatment area by chemical type (e.g., algaecides, systemics, contacts) and target species
2. Depth contours (Certain depth contour maps may be accessed and downloaded from the Department of Natural Resources (DNR) website by clicking here. If you are unable to locate a contour map, please estimate at a minimum the 5-foot depth contour.)
3. Water level control structures
4. Inlets and outlets
5. Wetlands
6. Private and public access sites and parks
7. The nearest road(s)
8. A map legend including lake name, county, sizes of waterbody and treatment area, key to the chemical types used in the proposed treatment area, a scale in feet, and a north directional arrow
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Authority to Undertake Treatment
Group of Individual Property OwnersAssociation (Lake/Condo/Homeowners/Other)Statutory Lake BoardTownshipOther
Include the contact information for the authorizing entity, including the name of the individual responsible for organizing treatment, the name of the entity (associations, township board, organization, etc.) requesting treatment, and contact information including address, telephone number and email.
Enter the contact information for all bottomland owners proposing treatment including phone number, and address or lot number. If the association owns all bottomlands proposed for treatment, please enter the contact information for the association. If five or more properties are proposed for treatment, provide the contact information for at least five bottomland owners in the proposed area of impact.
Applicants are required to obtain written authorization to chemically treat the proposed area of impact from each person who owns bottomlands in the proposed treatment area. The only exception to this requirement is when the applicant is providing, or has contracted to provide, chemical treatment for either of the following: (1) A lake board established under Part 309 for the waterbody for which chemical treatment is proposed, or (2) This state or a local unit of government acting under authority of state law to conduct lake improvement projects or to control aquatic vegetation.

An applicant applying on behalf of either (1) or (2) must provide a copy of the authorization letter (e.g., a contract).

All other applicants (e.g., applicants authorized by Lake Associations, Homeowners Associations, a Group of Individual Property Owners, etc.), must provide a copy of the written authorization for each property within the proposed treatment area.
Written Authorization(s) Upload(s)

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If unable to provide written authorization from each person who owns bottomland on the proposed treatment area, please explain why.
1 season2 seasons3 seasons4 seasons

Additional Information
Is there any additional information you would like to provide pertaining to the proposed treatment of the waterbody or sites? (e.g. specific management drives)?
Please provide any additional documents

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Should be Empty:

Waterbody/Site Details

Permit History

Treatment Information

Treatment Map

Authority to Undertake Treatment

Additional Information