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State of Wisconsin Riprap Shore Erosion Control <br /> Department of Natural Resources General Permit Application Packet RI-08 <br /> www.dnr,Ai.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 al I 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 /> Name of Owner/Authorized Representative(please print) Title Telephone Number <br /> -7> oc.7NEQ 71S-dlZS--91&5 <br /> 1/IFV/D t.J. O'AJE/LL 7/9-ftim-193-3 <br /> Signatu <br /> / - <br /> Signatu a Date Signed <br /> /i -Z(. -Zoo 46 <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 /> Date Application Received LR-2�7- <br /> ocket Number Date Application Completed Fee Received ATS <br /> $ J1.1aa it <br /> NHIChecked? Arcaeological&Historic Checked? ASSNNpI? PRF? PNW? Wetlands? <br /> Ew-rYes C3 No O Yes L3 No 10 Yes ❑ No ❑ Yes CeeNo ❑ Yes ❑ No @'Yes ❑ No <br /> State of Wisconsin Department of Natural Title <br /> ResoJb <br /> forth <br /> rate Signed <br /> IssueU'tM �w I <br /> Copies of this permit sent to: Cons tion Warden,U.S.Army Corps of Engineers and County Zoning Administrator To-L,,-p, <br />