____________________________________________________________________________________________________________
APPLICATION
TRIPLOID GRASS CARP STOCKING PERMIT
Fee: $50.00 (22.86)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
Importation Permit Requirement: An Importation permit, ($15) is required in addition to this permit to be able
to import Triploid Grass Carp into the state of Nevada. Please submit the Importation permit application at the
same time the Triploid Grass Carp Stocking permit application is submitted.
NOTE: When answering the following questions, a separate description must be provided for each
body of water on the property where the applicant wishes to stock certified triploid grass carp.
Separate, unconnected properties require separate applications.
Applicant is:
Property Owner
Property Manager
APPLICANT INFORMATION
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
NAME [LAST]
[FIRST]
[MIDDLE]
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
:
HOME PHONE
WORK PHONE
E-MAIL ADDRESS
:
:
:
:
:
HEIGHT
WEIGHT
HAIR
EYES
GENDER
:
:
DRIVER’S LICENSE NUMBER
STATE
DATE ISSUED
:
EMPLOYER
:
WORK ADDRESS
NAME, ADDRESS, AND PHONE OF PROPERTY OWNER
[If other than the applicant]
1. Address and legal description of the location of the pond or lake to be stocked with triploid grass carp:
2. The purpose for controlling vegetation in this closed aquatic system is because vegetation interferes with
Recreational use
Domestic use
Municipal use
Agricultural use
Industrial use of the water
OR
Vegetation impairs the quality of the water in the system.
3. What is the present use of the body of water?
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.86
Rev. Oct 2010
Page 1 of 2
____________________________________________________________________________________________________________
APPLICATION
TRIPLOID GRASS CARP STOCKING PERMIT
Fee: $50.00 (22.86)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
Importation Permit Requirement: An Importation permit, ($15) is required in addition to this permit to be able
to import Triploid Grass Carp into the state of Nevada. Please submit the Importation permit application at the
same time the Triploid Grass Carp Stocking permit application is submitted.
NOTE: When answering the following questions, a separate description must be provided for each
body of water on the property where the applicant wishes to stock certified triploid grass carp.
Separate, unconnected properties require separate applications.
Applicant is:
Property Owner
Property Manager
APPLICANT INFORMATION
TAX ID:
SPORTSMAN’S ID or SSN:
DATE OF BIRTH:
NAME [LAST]
[FIRST]
[MIDDLE]
:
PHYSICAL ADDRESS
:
:
:
CITY
STATE
ZIP
:
MAILING ADDRESS
:
:
:
CITY
STATE
ZIP
:
:
:
HOME PHONE
WORK PHONE
E-MAIL ADDRESS
:
:
:
:
:
HEIGHT
WEIGHT
HAIR
EYES
GENDER
:
:
DRIVER’S LICENSE NUMBER
STATE
DATE ISSUED
:
EMPLOYER
:
WORK ADDRESS
NAME, ADDRESS, AND PHONE OF PROPERTY OWNER
[If other than the applicant]
1. Address and legal description of the location of the pond or lake to be stocked with triploid grass carp:
2. The purpose for controlling vegetation in this closed aquatic system is because vegetation interferes with
Recreational use
Domestic use
Municipal use
Agricultural use
Industrial use of the water
OR
Vegetation impairs the quality of the water in the system.
3. What is the present use of the body of water?
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.86
Rev. Oct 2010
Page 1 of 2
4. What is the source of water for the body of water to be stocked?
5.
YES
NO Will the outflow from the closed aquatic system enter any other body of water or aquatic
system? If YES, what is the name, location, and distance to that body of water?
6. What species of fish are presently in the closed aquatic system?
7. What is the approximate number of surface acres of the body of water?
8. What is the average depth of the body of water?
9. Number of triploid grass carp to be stocked?
10. Vendor name and address for the source of triploid grass carp to be imported and stocked?
11.
I, the signator, in signing this application, hereby state that I am entitled to this permit under the laws of the State of
Nevada and that no false information or false statement has been made by me to obtain this license.
_____________________________________________________________
__________________________________
Signature of Applicant
Date
Submit your completed application and fee to the appropriate office below:
Western Region
Southern Region
Nevada Department of Wildlife
Nevada Department of Wildlife
Special Licenses and Permits
4747 Vegas Dr.; Las Vegas, NV 89108
1100 Valley Rd, Reno, NV 89512
Telephone: (702) 486-5127
Telephone: (775) 688-1500
Counties: Clark, Esmeralda, Lincoln, Nye
Counties: Carson City, Churchill, Douglas,
Humboldt, Lyon, Mineral, Pershing, Storey, Washoe
Eastern Region
Nevada Department of Wildlife
60 Youth Center Road; Elko, NV 89801
Telephone: (775) 777-2300
Counties: Elko, Eureka, Lander, White Pine
FOR DEPARTMENT USE ONLY
Date Received:
Date Approved:
Date Returned for Additional Information:
Date Disapproved:
Department Representative:
REASON FOR DISAPPROVAL:
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.86
Rev. Oct 2010
Page 2 of 2
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