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State of Wisconsin Attachment-Riprap <br /> Department of Natural Resources General Permit Application Packet(Rt-09) <br /> www.dnrwi.gov page 2 of 4 <br /> Section 3: Submittal Requirements <br /> Yes <br /> I have submitted a$50 PERMIT APPLICATION FEE, in the form of a check,payable to"Wisconsin DNR." <br /> I have prepared and submitted DETAILED PLANS AND/OR DRAWINGS,which clearly illustrate the project <br /> has been designed and will be constructed in compliance with all of the General Permit Eligibility Standards. <br /> I have submitted LEGIBILE SITE MAPS,which clearly illustrate the perimeter of the construction site and <br /> relationship to nearby water resources(e.g.lakes,rivers,streams,wetlands)and major landmarks and roads. <br /> I have submitted CLEAR PHOTOGRAPHS,which illustrate the entire project site in pre-construction <br /> condition and the relationship to nearby water resources. <br /> I have submitted a COMPLETED GENERAL PERMIT ATTACHMENT and provided 3 COPIES of the entire <br /> application package. <br /> Section 4: Certification <br /> Yes <br /> I hereby certify that I am the owner or authorized representative of the owner of the property which is the <br /> subject of this permit application. <br /> I certify that the project has been designed and will be constructed in compliance with all of the General <br /> Permit Eligibility Standards. <br /> I certify that the information contained in this application submittal is true and accurate and understand <br /> that failure to comply with any or all of the provisions of the issued permit may result in permit revocation,a <br /> fine and/or imprisonment or forfeiture under the provisions of applicable laws. <br /> I understand that I am responsible for obtaining all necessary local(e.g.city,town,village or county) <br /> and US.Army Corps of Engineer permits or approval in addition to this state General Permit and prior to <br /> commencing any work at the project site. <br /> Section 5: Permission <br /> Yes <br /> I hereby give the Department permission to enter and inspect the property at reasonable times,to <br /> evaluate this notice and application,and to determine compliance with any resulting permit coverage. <br /> Section 6: Landowner or Authorized Representative Signature <br /> Please sign below. By signing you are certifying that all of the requested items contained in this permit application <br /> attachment has been fulfilled and the appropriate documentation is attached. <br /> Name of Owner/Authorized R presentative(please print) Title Telephone Number <br /> Sig r Date Signed <br /> D 'aDd <br />