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G P-Na - 2oaQ- ri-oq ;L-'4..— <br /> This <br /> L-' ..— <br /> This is your RIPRAP SHORE EROSION COFnNctdon <br /> 46t <br /> IT. <br /> Please fill out the form below. A DNR water manag ��ulg[�i�v rmit application and determine whether <br /> your project meets the eligibility standards outlinen Packet A permit cannot be Issued until <br /> you submit all of the required information and meet eligibility standards detailed below. After It is determined the project is <br /> eligible for a General Permit you will receive this permit application signed and dated by an authorized Department of Natural <br /> Resources employee. Once you receive this permit application form with an authorized signature the permit is"Approved" <br /> Name Contact Person Title <br /> J itlie A-,- <br /> Mailing Address City State Postal Code <br /> 17 <br /> S >/,s A-) S67/0 <br /> E-mail address Telephone Number(Include area code) Fax Number(include area code) <br /> .�.yi tlie� e . T a/Vtto 0- 66Y.1% 9 —712 Z <br /> ❑ Consultant PU Contractor ❑ Agent ❑ Other If Other,specify: <br /> Name / Contact Person TitleIi <br /> Corn 114T LanJs i I 06A, -7 c ✓`- <br /> Mailing Address C State Postal Code I <br /> s D ! 5 { L t lti- <br /> E-mail aad�dress Telephone Number(include area code) Fax Number(include area code) <br /> C�omlahJc eL.r � wat�kvl 3(1- (x (000 ( d 3 ld -7 <br /> .1s. <br /> Site Name(if any) County ^ Municipality(check one) rr <br /> l�X E3 city Town ❑ Village of sC'd� <br /> Site Address or Description of Site Location <br /> 1 n�r <br /> PLSS blit nd survey ystem)Method <br /> ' ,J L c /riKlr s+ size s � '} 1 ;:fit <br /> WN <; - <br /> ❑ NW ❑ NE ❑ NW ❑ NE ❑ E <br /> SW ❑ SE go SW ❑ SE / N T 1$� W <br /> Latitude and Longitude Method <br /> Degrees Minutes Seconds Method of Determining <br /> Latitude ❑ GPS <br /> ❑ DNR Surface Water Data Viewer or WebView <br /> Longitude ❑ Other(please specify): <br /> �nn y ffl <br /> BUMP <br /> Waterway Name or Description(if unnamed) <br /> Midohle- V'10 vta/e Lakes <br /> Will this project effect wetlands? ❑ Yes )W No ❑ Unsure <br /> NOTE If wetlands will befilled,exavated,ordisturbed during mnstructlon or as part of this prosect,wetland water quality cert ( . <br /> The presence of wetlands has been evaluated using: (check all that apply) A <br /> ❑ Wisconsin Wetlands Inventory ❑ Soils(NRCS Maps) ❑ Wetland Deline n(attach repo>lt)0 Q90 her <br /> ®NER D/VR <br />