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Water Resources Application for Project Permits <br /> Fore 3500-053 IR 08108 P 2 <br /> Applicant/ ject Nam�-/ii All COuntY. j->, ,P /V fr 7rr <br /> Latitude and Lon nude Method if available <br /> Dearees Minutes Seconds Method of Determining <br /> Latitude ❑GPS <br /> ❑DNR's Surface Water Data Viewer <br /> Longitude ❑Other(specify): <br /> Section 6:Waterways and Wetlands see Instructions about potential additional applicationrequirements) <br /> Name(description if unnamed)of closest waterbod(es Type Special status <br /> — fcty I <br /> Lake [IStream ElORW(ERW El303(d)listed <br /> Yes No Wetlands: <br /> ❑ ® Wetlands will be filled excavated or disturbed during construction or as part of this project. <br /> The presence of wetlands has been evaluated using:(check all that apply) <br /> ❑Wisconsin Wetlands Inventory ❑Weiland Delineation(attach report) <br /> ❑Vyetiand Locator Tool ❑Soils(NRCS maps) ❑Other(specify) <br /> hftb://dnr.wi.gov/wetiands/locating.htmi <br /> Section 7:Protect Information Attach additional sheets as necessa <br /> Duration: Anticipated Project Start Date(monwday/year) Projected Project End Date(mono ryear) <br /> Photos:Provide photographs of the"before"conditipir. Date of Photographs: <br /> Narrative of the Project: <br /> Provide a one to two paragraph description of the proposed project, including land and water alterations and interided <br /> use(s)ofthe projed.�� MB/0� c©�� p � :A4 FsFlp7 <br /> R. w � 4!r;E �/ rF/ / 4� re 6 ',3 /\ e G K <br /> Section 8 Attachments and Permit Access(Include appropriate attachments for each proposed activity.) <br /> The following attachments,together with this form,constitute this permit application: (include all that apply) <br /> Attachment Names),rp g M 5 J a O- b'3 A /V'q <br /> Co Aj 7-,,e r C t 8 Aa e ©S /Al 0(,U D S6 0 / M 4-,yT C o A.)7-4 o C, <br /> 1 have obtained a copy of the construction site storm water runoff general permit from the departments Internet site. <br /> httr./ldnr wi aov/runoff/i)df/stormwater/oermita/construction/construction permit 5067831-3.odf <br /> Section 9:Certification&Permission <br /> Certification: I hereby certify that 1 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 <br /> accurate. I understand that failure to comply with any or all of the provisions of the permit may result in permit revocation <br /> and a fine and/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 <br /> this notice and application,and to determine compliance with any resulting permit coverage. - <br /> Name of Owner/Authorized Representative(Print or" Title Telephone Number <br /> f Cv,c� 6S/- 4ig y 941 757 <br /> Signature ate Sign <br /> LEAVE BLANK-AGENCY USE ONLY <br /> Date Regeiveg Fee Received construction Site ID# Docket#SR-A) - Corps# <br /> Dr1/aa/ /cl $ <br /> Initial ing: C <br /> 32'Completeness ®Historic checked I'mare species(NHP checked Hands checked <br /> Cc: Corp.S of t:pnI,neerS , 411 r1 wc.rd <br /> aurae_-{+ w• Zming r s i r(fi <br /> Warder` Pavel Marhn , Wti6s4w R.S. <br /> V a 1 Sc.,-r.>& r-17- <br /> , coyrfr^u C fl9r <br />