"Special Area Permit Application" - Alaska

Special Area Permit Application is a legal document that was released by the Alaska Department of Fish and Game - a government authority operating within Alaska.

Form Details:

  • The latest edition currently provided by the Alaska Department of Fish and Game;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Alaska Department of Fish and Game.

ADVERTISEMENT
ADVERTISEMENT

Download "Special Area Permit Application" - Alaska

245 times
Rate (4.5 / 5) 15 votes
FH #
(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
A.
APPLICANT
Name: _____________________________________________________________________________
Company:
Address:
City/State/ZIP:
E-Mail:
Telephone:
Fax:
Name of Responsible Party in the Field:
B.
LOCATION OF PROJECT SITE:
Name of Special Area:
Specific Project Location:
Township
Range
Meridian
Section(s)
USGS Map
Latitude
Longitude
(NAD 83)
Is the project on:
State Land
Private Land
Federal Land
Municipal Land
Ownership Unknown
Other
Water bodies crossed or otherwise affected:
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.
The timeframe for the project or activity, including the specific time periods for any inwater work or other
activities which may disturb fish or wildlife.
1 -
-
FH #
(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
A.
APPLICANT
Name: _____________________________________________________________________________
Company:
Address:
City/State/ZIP:
E-Mail:
Telephone:
Fax:
Name of Responsible Party in the Field:
B.
LOCATION OF PROJECT SITE:
Name of Special Area:
Specific Project Location:
Township
Range
Meridian
Section(s)
USGS Map
Latitude
Longitude
(NAD 83)
Is the project on:
State Land
Private Land
Federal Land
Municipal Land
Ownership Unknown
Other
Water bodies crossed or otherwise affected:
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.
The timeframe for the project or activity, including the specific time periods for any inwater work or other
activities which may disturb fish or wildlife.
1 -
-
A description of construction methods, types, and quantities of equipment and number of people involved.
A description of water use including methods of withdrawal, rate of withdrawal, and the total quantity of
water required.
A list of fill and excavation quantities, including the types of material and the source.
A map and description showing how access will be gained to the project area (use USGS 1:63,360 scale
maps where available).
A detailed map or plan view, drawn to scale, and any cross-sectional views necessary to show project
features and local topography including the location of all facilities and project dimensions.
A current aerial photograph of the project location (if available).
D.
OTHER PERMITS
Identify other state or federal permits or authorizations obtained or for which you have applied:
MITIGATION: As a condition of project approval, applications will be required to compensate fully for damage to fish and
wildlife and their habitat by employing the most appropriate techniques. Where determined necessary by the department, a
mitigation plan pursuant to 5 AAC 95 will be required.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED ON OR IN CONNECTION WITH THIS
APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
Signature of Applicant
Date
Name of Applicant (please print)
PLEASE SUBMIT APPLICATION BY EMAIL, POSTAL MAIL, OR IN PERSON TO THE NEAREST
DEPARTMENT OF FISH AND GAME, HABITAT SECTION OFFICE.
DOUGLAS (JUNEAU)
ANCHORAGE
CRAIG
dfg.hab.infoanc@alaska.gov
dfg.hab.infocga@alaska.gov
dfg.hab.infodou@alaska.gov
333 Raspberry Rd, Ste 2068
PO Box 668
PO Box 110024
Anchorage, AK 99518
Craig, AK 99921
Juneau, AK 99811-0024
FAIRBANKS
SOLDOTNA (KENAI)
MAT-SU/PALMER
dfg.hab.infofai@alaska.gov
dfg.hab.infosxq@alaska.gov
dfg.hab.infopaq@alaska.gov
1801 Margaret Dr., Ste 6
1300 College Rd
514 Funny River Rd
Fairbanks, AK 99701
Soldotna, AK 99669
Palmer, AK 99645
2 -
-
Page of 2