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•T o 11 W'L� <br />s4 I a VII®RKSH E o�I�por att ofept' ' , <br />> <br />}jet _ _ _ <br />'1 ' {i t:� Y 4.. 1 <br /># �1 au�ti ., ,a n r ui .y_: _ti« tit, 'S t at g f r� <br />MUR -`�III <br />'j' .'�•t�•i�=.s3= V=s'Ji,Mgi--{i�j�JM7ggm'#kY �� FhS` 'iW r' <br />Co nu Rr rp r spor+i atlo L►g son x+,_IR•�� .ay. �"41!�'dpo{fyo . U. tTr, nsportataon tip{an,go toh..ttp//dnr wr ctot<(;searc '!l e;=€�I{, <br />lra s ortatron F �; <br />�� <br />Applicant/ Road Owner (Town, Village, City or County): <br />Road Name: <br />(O w A a � Lk sue, <br />Municipal Representative's Name: <br />Stream Name: <br />+ d55 �r�14_ <br />Address, City, State, Zip Code: <br />County: <br />A <br />Legal Description: <br />NE 1/4, N F '1/4; Section <br />Townshli_ North, Range East West <br />Telephone Number: <br />Project Start Date: Project End Date: <br />E-mail Address: <br />Project Start and End Location (attach map if necessary): <br />�c�c�r.'Sovz-icsw v��t�\� y�tinct Crime <br />Contractor / Consultant Contact Information (if available): <br />General Project Information (check all that apply) <br />Wetlands present <br />Streams/ Lakes present <br />Stream culvert(s) replacement <br />Bridge replacement <br />New culvert or bridge (currently no crossing present) <br />Riprap placement <br />Road surface / mill & overlay <br />Road reconstruction <br />Road widening/ fill outside toe of slope <br />New road layout (currently no road present) <br />Road /hill / curve realignment <br />Clearing & Grubbing <br />Storm sewer replacement <br />Ditch work <br />1. Briefly describe the current situation and why corrective actions are needed including any safety concerns. <br />2. Will wetlands be impacted? If so, provide an estimate of potential wetland fill (square feet). <br />