Form - Chemical Fish Renovation

Applicant Information

First Name* Required

Last Name* Required

Address

City

State

Zip

Phone

County

Section

Township

Range

Waterbody Information

Directions to waterbody from nearest town

Is this water totally surrounded by private land

Yes No

Yes No

When Full, Surface Acres

When Full, Maximum Depth

When Full, Average Depth

Current size, Surface Acres

Current size, Maximum Depth

Current size, Average Depth

Yes No

Yes No

Year last stocked with fish

Species of fish present* Required

Reason for fish eradication* Required

Tentative date of eradication* Required

The Department of Game, Fish and Parks assumes no responsibility for the success or failure of the project or for the restocking of fish.