Form SLAP22.69 "Application for Dredging Permit" - Nevada

What Is Form SLAP22.69?

This is a legal form that was released by the Nevada Department of Wildlife - a government authority operating within Nevada. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on October 1, 2010;
  • The latest edition provided by the Nevada Department of Wildlife;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form SLAP22.69 by clicking the link below or browse more documents and templates provided by the Nevada Department of Wildlife.

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Download Form SLAP22.69 "Application for Dredging Permit" - Nevada

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____________________________________________________________________________________________________________
APPLICATION
DREDGING PERMIT
Fee: $15.00
(22.69)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
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
:
EMPLOYMENT ADDRESS
:
:
:
CITY
STATE
ZIP
1. Description of dredge(s) to be used (limit 3); maximum intake diameter – 4 inches:
MAKE
MODEL
INTAKE SIZE
(inches)
1.
2.
3.
2. Water name, location, and proposed dates of dredging (limit 10):
Continued on page 2
NAME OF WATER
MOUNTAIN RANGE OR
COUNTY
DATES OF
VALLEY
DREDGING
1.
2.
3.
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.69
Rev. Oct 2010
Page 1 of 2
____________________________________________________________________________________________________________
APPLICATION
DREDGING PERMIT
Fee: $15.00
(22.69)
Please PRINT all information except for your signature. Incomplete or illegible applications will be returned.
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
:
EMPLOYMENT ADDRESS
:
:
:
CITY
STATE
ZIP
1. Description of dredge(s) to be used (limit 3); maximum intake diameter – 4 inches:
MAKE
MODEL
INTAKE SIZE
(inches)
1.
2.
3.
2. Water name, location, and proposed dates of dredging (limit 10):
Continued on page 2
NAME OF WATER
MOUNTAIN RANGE OR
COUNTY
DATES OF
VALLEY
DREDGING
1.
2.
3.
____________________________________________________________________________________________________________
STATE OF NEVADA – Department of Wildlife
SLAP 22.69
Rev. Oct 2010
Page 1 of 2
2. Water name, location, and proposed dates of dredging
:
(continued from page 1)
NAME OF WATER
MOUNTAIN RANGE OR
COUNTY
DATES OF
VALLEY
DREDGING
4.
5.
6.
7.
8.
9.
10.
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
Mail or submit your application and the required fee to the appropriate Department office in the region where
the dredge will be primarily operating:
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 22.69
Rev. Oct 2010
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