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State of Wisconsin Ri ra Re <br /> Department ofNatural Resources Riprap Paireneral Permit tA Replacement <br /> GApplication Packet R1-08 <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 /> Name of Owner/Authorized Representative(please print) Title 11 Telephone Number <br /> Signature Date 'gned <br /> So <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 Docket Number Date Application Completed Fee Received <br /> NHI Checked? Arcaeological&Historic Checked? ASNRI? PRF? PNW? Wetlands? <br /> ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No <br /> State of Wisconsin Department of Natural Title <br /> Resources <br /> for the Secretary <br /> Date Signed <br /> Issued by <br /> Copies of this permit sent to: Conservation Warden,U.S.Army Corps of Engineers and County Zoning Administrator <br />