Aquatic Farm Operation Permit Renewal Or Transfer Application Form - Alaska Department Of Fish And Game

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Alaska Department of Fish & Game
Aquatic Farm Operation Permit Renewal
or Transfer Application Form
5 AAC 41.280
ADF&G Aquatic Farm Operation Permit Number: DFG-_____-_____-AF-S___
Department of Natural Resources, Division of Mining, Land and Water
Aquatic Farm Lease, File No.: ADL_____________
Current Permittee Information
Name_____________________________ Doing Business As______________________
Mailing Addresss_________________________________________________________
City ___________________________ State _______________ Zip Code ____________
Contact Phone _____________ Email _________________ Cell Phone ______________
I wish to ( Renew / Transfer* ) my Aquatic Farm Operation Permit.
(circle one)
* If this is an application to transfer your Aquatic Farm Operation Permit, complete the next section.
You must contact the Alaska Department of Natural Resources at (907) 269-8543, to apply for a lease
transfer or renewal.
New Permittee Information
(if applicable)
Name_____________________________ Doing Business As______________________
Mailing Addresss_________________________________________________________
City ___________________________ State _______________ Zip Code ____________
Contact Phone _____________ Email _________________ Cell Phone ______________
A $100 renewal or transfer fee is required at the time that this application is submitted.
Make checks payable to the Alaska Department of Fish and Game (ADF&G). Mail
your completed application and fee to ADF&G Mariculture Coordinator, Division of
Commercial Fisheries, P.O. Box 115526, Juneau, AK 99811-5526. Place your
ADF&G permit number on the check.
The information contained herein is true and complete to the best of my knowledge.
Signature of Current Permittee
Date
Address questions to Cynthia Pring-Ham at (907) 465-6150 or cynthia.pring-ham@alaska.gov

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