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State of Wisconsin Riprap Shore Erosion Control <br /> Department of Natural Resources General Permit Application Packet Rt-08 <br /> www.dnr.wi.gov page 7 of 12 <br /> Section 9(cont'd): Permit Conditions <br /> 9. Acceptance of a general permit and efforts to begin work on the activity authorized by the general permit signifies that the <br /> permittee has read,understood,and agreed to follow all conditions of the general permit. <br /> 10. This project shall comply with all conditions identified in Wisconsin Administrative Code NR 328,and identified in the <br /> Instructions for the General Permit application. <br /> Section 10: Certification&Permission <br /> Certification: 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. I certify that the information contained in this form and attachments is true and accurate. I <br /> understand that failure to comply with any or all of the provisions of the permit may result in permit revocation and a fine and/ <br /> or imprisonment or forfeiture under the provisions of applicable laws. <br /> Permission: I hereby give the Department permission to enter and inspect the property at reasonable times,to evaluate this <br /> notice and application,and to determine compliance with any resulting permit coverage. <br /> NamgQ,f Owner/Authorized Representative(please print) Title Telephgrle Number J (4 <br /> Oa r 4Ss r C C Jn. �? r , t 4v o�J <br /> Signatu� � Date Signed <br /> THIS PERMIT APPLICATION IS APPROVED WHEN IT IS SIGNED AND DATED BELOW BY AN AUTHORIZED DEPARTMENT <br /> OF NATURAL RESOURCES EMPLOYEE. <br /> DNR WMS USE ONLY <br /> Dat Application Received Docket Number Date A lic ion Completed Fee Received <br /> �I/v_ aq �� o 09 $jErYe!sLl <br /> ,oZ7 <br /> NNHI/Checked? Arcaeologicall&/HistoricChecked? AAS RI? PRF? ILLI <br /> etlands? <br /> IFI Yes ❑ No ❑ Yes LY No LTJ Yes ❑ No ❑ Yes Q"No No Yes No <br /> State of Wisconsin Department of Natural llt(e <br /> Resources 1 / <br /> for the Se ry Date Signed <br /> Issued by "/L)—� <br /> Copies of this permit sent to: Con ation Warden,U.S.Army Corps of Engineers and County Zonin Administrator <br /> cu Marl rn JaSov% BcrKX1l �r�w �(snr �4t <br /> 0JS0 : C'-'oMQ1V+e LOL*% K �dEdY- RECEIVED <br /> AUG 10 2009 <br /> SPOONER DNR <br />