Special Area Permit Application - Department Of Fish And Game
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1
2
3FG#______________
(OFFICE USE ONLY)
ALASKA DEPARTMENT OF FISH AND GAME
SPECIAL AREA PERMIT APPLICATION
(For approval of a project or activity within a
state game refuge, game sanctuary, or critical habitat area)
Pursuant to 5 AAC 95
This
application
must
be
completely
filled
out
in
order
for
the
department to consider approval of a proposed project or activity.
Please type or print clearly in ink.
If a question is not applicable to
your project, or you do not know the answer, please so indicate on the
appropriate line.
A.
APPLICANT
Name:_______________________________________________________________
Company:____________________________________________________________
Address:____________________________________________________________
____________________________________
Phone (day):
__________________
Name of Responsible Party in the Field:_____________________________
B.
LOCATION OF PROJECT SITE
Name of Special Area:_______________________________________________
Specific Project Location:__________________________________________
Township
________
Range
________
Meridian _______
Section
_______
Quarter Section ________
USGS Map ________
Is the project on:
private land _______
state land _______
federal land _______
municipal land _______ ownership unknown _______
Waterbodies crossed or otherwise affected:__________________________
______________________________________________________________________
«
Is the project in the coastal zone?
Yes ________
No ________
If yes, attach a completed Coastal Project Questionnaire to this
application.
C.
DESCRIPTION OF THE PROJECT OR ACTIVITY
On
separate,
attached
sheets
provide
complete
plans
and
specifications and all other details necessary to fully describe
the scope of the proposed project or activity.
Include, at a
minimum, the following information:
The purpose of the project or activity.
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