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City and County of Broomfield Prairie Dog Policy Prairie Dog Control Permit Application Pro-forma Permit and (Residential Lots 5 Acres or Less in Area or Exceptions Applicable to Non-Residential Parcels and Residential Lots Larger than 5 Acres) Please provide the following information to the Open Space and Trails Department: Name of Applicant: Telephone: Email: Name of Landowner: Telephone: Email: Address of the Subject Property: Date of Application: Description of Request: Name of Licensed Exterminator: Telephone: Address: Email: (Please include a copy of the exterminator’s license) Please specify the category for which this qualifies for a pro-forma lethal control permit as outlined in the Broomfield Policies for Prairie Dog Conservation and Management, Section 4.7 “Exception for Emergency Responses”, page 7. ---PAGE BREAK--- □Dam and Ditch Embankments □Parkland, Ball fields, Playgrounds, Trails □Sick or Injured Prairie Dogs □Roadways, Parking Lots □Landscaping of Public Buildings or Facilities □Encroachment onto Private Property □Other Areas Please Please specify proposed method and toxicant for control (see below) Method and Toxicants for Prairie Dog Control: Lethal control of prairie dogs must be performed by an approved method and an approved exterminator pursuant to the Prairie Dog Policy of the City and County of Broomfield. The only method currently approved for lethal control within Broomfield is by toxicants. Only toxicants approved by the Environmental Protection Agency (EPA) shall be used. Currently, these toxicants include aluminum phosphide pellets (a fumigant), and carbon monoxide gas (a fumigant). Any exterminator with a prior violation of a City or State permit shall not be approved. No other means of lethal control such as poison bait, shooting, drowning, lethal trapping, or other method is permitted in any circumstance. Burrowing Owl Review: Please attach results of a burrowing owl study for the subject property. See further description below. Prior to relocation or removal of all or part of a prairie dog colony during the burrowing owl nesting season (March 15th through October 31st), the prairie dog town shall be surveyed by a qualified biologist for the presence of burrowing owls. The burrowing owl, which nests in vacant prairie dog burrows, is listed by CDOW as a threatened species in Colorado and protected by USFWS under the federal Migratory Bird Treaty Act. If burrowing owls are found to be nesting within a prairie dog town, the City shall postpone any relocation or control measures until after the nesting season. If postponing prairie dog relocation or control would represent an undue hardship for the City or its citizens, the City may apply to USFWS for authorization to implement the proposed action during the nesting season. For more information please review section 4.9 of the complete prairie dog policy. ---PAGE BREAK--- Signage and Notice for Public Land: All lethal control projects on public land will now have signage at the extermination site to notify the public that prairie dog management is occurring. The signage will state that a pesticide or toxicant is being used for prairie dog management and that the area is temporarily closed to the public. Utility-type flagging (small colored flags about 12” high) will also be placed in the area undergoing prairie dog management. The flags will also note that a toxicant is being used in the area. In the case of a control project along a trail, the trail will be closed in the area being treated and caution tape will be extended across the trail at any entrances into the area. The public notice signage for both carbon monoxide and aluminum phosphide must be posted 24 hours before the treatment begins. In cases where carbon monoxide is used, the signage must be posted for 24 hours after treatment and in cases where aluminum phosphide is used, the public notice signage is required for 72 hours after treatment. Please refer to the 2006 administrative changes and policy adjustments for a summary of requirements regarding signage, notice, and area closures. This information is available at the Open Space and Trails website at http://www.ci.broomfield.co.us/openspace/. Damages to surrounding landscape: Project sites will be inspected after the project is completed to insure that there is no unnecessary damage to the surrounding area. If there is excessive damage to the landscape as a result of the project, the contractor will be expected to work with City staff to reseed the area and mitigate the damages. Pro-forma permits shall be issued at no cost to the applicant. Please review the complete Prairie Dog Policy and the administrative changes and policy adjustments before applying for this permit or taking any action. The policy and the adjustments are available at the Open Space and Trails Department at the Broomfield City and County Building or online at: www.ci.broomfield.co.us/openspace/ ---PAGE BREAK--- The undersigned has read, understood, and agreed to the conditions contained herein and officially represents the Applicant on this permit. Printed For Broomfield Use Below Date Reviewed Date