Application For Long Term Seed Oyster Transplant (Relay) License I-B For Prohibited And Conditionally Restricted-Relay (Closed) Areas - State Of Connecticut Page 2

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PART III. - BOAT IDENTIFICATION:
A recent photograph of each boat must
Page 2 of 2
accompany this application.
I .
Name
Registration No
Size
Color
Make
Marine head with discharge
Yes
No Documented
Captain
Date of Birth:
Owner/Other Information
2.
Name
Registration No
Size
Make
Color
Marine head with discharge
Yes
No
Documented
Captain
Date of Birth:
Owner/Other Information
Part IV. - WHEN ANY SHELLFISH IN PART I ARE BROUGHT TO SHORE.
I .
Name of individual/Company transporting shellfish listed in Part I.
Location of Landing/Loading Docks.
2.
(Name of Dock)
(Street)
(Town)
(State)
3.
Vehicle to be used for transporting
(Type, make, color, year)
4.
Expected dates of start and completion of the landing/loading operations.
(Be specific - extensions can be applied for if needed)
Location of Receiving Point for shellfish transported in Vehicle noted in #3.
5.
(Name of Dock)
(Street)
(Town)
(State)
6.
IF SHELLFISH ARE TO BE STORED AT THIS LOCATION (Noted in #5) RATHER THAN LOADED ON BOAT FOR
IMMEDIATE DELIVERY TO WATERS LISTED IN PART II, PLEASE NOTE AREA, METHOD AND LENGTH OF STORAGE.
(Area and Method of Storage)
(Expected length of Storage)
7. SECURITY PROVIDED:
I declare that I have legal authority to transplant (relay) shellfish from/to areas indicated and that I will conform to all agreed to licensed
activities, regulations and statutes. I understand that any person making a written false statement on this application shall be subject to
arrest as provided for in Section 53A- 157 of the Connecticut General Statutes.
President/Owner if different from above:
Date of Birth:
Applicant
Date:
AQ-36-1B & 36b (Rev. 4/99)
.pdf

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