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State of Wisconsin Riprap Repair or Replacement <br /> Department of Natural Resources General Permit Application Packet R1-08 <br /> www.dnrwi.gov <br /> page 4 of 12 <br /> This is your RIPRAP REPAIR OR REPLACEMENT PERMIT. <br /> Please fill out the form below. A DNR water management specialist will review the permit application and determine whether <br /> your project meets the eligibility standards outlined in Section 6 of the General Permit 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 /> Section 1: Landowner(Applicant)Information <br /> N �` SCn Con t Person Title <br /> ` r% <br /> Mailing Address Cit $�� State Postal Code <br /> dov\ Y q 3 <br /> E-mail address Telephone Number(include area code) Fax Number(include area code) <br /> S - <br /> Section 2: Other Contact Information <br /> ❑ Consultant NE Contractor ❑ Agent ❑ Other If Other,specify: <br /> P fy: <br /> Name p Contact PersonTitle <br /> �.e��Ck>z L a�tal3ca in Ai r6- L4cc�{'�t O v oi-te <br /> Mailing Address City State Postal Code <br /> 1.lt-1 o SkiS•JA 4r �s�owr W1 Dire YO <br /> E-m it address (� 'Telephone Number(in ear a cc*) Fax Nuum`ber(include area code) <br /> �ult���q/tOLSCO E.Q �Jrf S -tV <br /> Section 3: Site Informati <br /> Site Name(If any) Co�inty Municipality( heck one) <br /> tt�r�� ❑ City Town ❑ VillageofLiala _ <br /> Site Address or Description of Site Location <br /> X364 r^[L&r&^ f <br /> PLSS(Public Land Survey System)Method <br /> Quarter-Quarter Quarter Section I Township Range Direction <br /> ❑ NW ❑ NE ❑ NW ❑ NE ❑ E <br /> ❑ SW ❑ SE ❑ SW ❑ SE N <br /> ❑ W <br /> Latitude and Longitude Method <br /> Degrees Minutes Seconds Method of Determining <br /> Latitudel �l ❑ GPS <br /> t l goo ;BbNR Surface Water Data Viewer or WebView <br /> Longitude a a4 /_ ❑ Other(please specify): <br /> Section 4: Waterway and Wetland Information <br /> Waterway Name or Description(if unnamed) <br /> o w r!6L IPL <br /> Will this project effect wetlands? ❑ Yes No ❑ Unsure <br /> NOTE: If wetlands will be filled,excavated,or disturbed during construction or as part of this project,wetland water quality certification(WQQ is required. <br /> The presence of wetlands has been evaluated using: (check all that apply) <br /> ❑ Wisconsin Wetlands Inventory ❑ Soiis(NRCS Maps) ❑ Wetland Delineation(attach report) ❑ Other <br />