Swallow-Wort Treatment Consent 2021

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This form is used to grant a property owner's consent to allow the CAKE CISMA to survey and conduct appropriate treatments for the control of priority invasive species on the property.

mail: CAKE CISMA 4820 Stover Rd, Bellaire MI 49690
phone: (231)533-8363 ext.5

Email *

Property owner name(s) *

Treatment property location (address or GPS coordinates) *

Property parcel number

Owner mailing address *

Owner daytime phone number(s) *

Tenant name (if applicable)

Tenant phone number

Special Instructions Regarding Property Access (landscape features, animals, gates, preferred access times, etc.:

Landowner Consent *

By checking this box, the above named persons certifies that they own the property, and have the requisite authority to grant the authorizations provided in this document and to agree to this document without the need for approval from any other party, or if any such approvals are needed they have been obtained.

Required

Consent to Treat Black Swallow-Wort *

By checking this box, the property owner authorizes the Charlevoix, Antrim, Kalkaska, and Emmet Counties Invasive Species Management Area (CAKE CISMA) or its authorized contractors, to enter and cross the above-described property for the purpose of surveying for and controlling Black Swallow-Wort with the application of formulations of the herbicide triclopyr approved by the State of Michigan for that purpose.

Required

Elecronic signature of owner: *

Date of agreement (Valid for one year) *

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