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State of Wisconsin Riprap Shores E osi Control <br /> Department of Natural Resources General Permit Application Packet RI-08 <br /> www.dnr.VA'.gov page 4 of 12 <br /> 6P-NO-28-0� -oo '-71920 <br /> This is your RIPRAP SHORE EROSION CONTROL 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 /> Name Contact Person Title <br /> DAVID W- O'A/k#, L SAME 4A bOWAJ6K <br /> Mailing Address City State Postal Code <br /> 15Z 5Y&L4 ST R,ve R F4Lt s W 1 SL/0a a <br /> E-mail address 00011CA57— Telephone Number(include area code) Fax Number(include area code) <br /> ol!W ones LL G . hf4rr <br /> Section 2: Other Contact Information <br /> ❑ Consultant ❑ Contractor ❑ Agent ❑ Other If Other,specify: <br /> Name Contact Person Title <br /> Mailing Address City State Postal Code <br /> E-mail address Telephone Number(include area code) Fax Number(include area code) <br /> Section 3: Site Information <br /> Site Name(if any) County Municipality( heckone) 0.4KLAA.7 <br /> 16URvETr ❑ City 0 Town ❑ Village of <br /> Site Address or Description of Site Location <br /> 7 ZS L.ACrooAJ4RM6 8�6 YE�c.ow4►�{� EsfsllEs <br /> PLSS(Public Land Survey System)Method <br /> Quarter-Quarter Quarter Section Township Range Direction <br /> W ❑ NE ❑ NW E I� ❑ E <br /> SW ❑ SE ❑ SW Zq 'J� N <br /> SE �� W <br /> Latitude and Longitude Method <br /> Degrees Minutes Seconds Method of Determining <br /> Latitude ❑ GPS <br /> ❑ DNR Surface Water Data Viewer or WebView <br /> Longitude ❑ Other(please specify): <br /> Section 4: Waterway and Wetland Information <br /> Waterway Name or Description(if unnamed) <br /> $16 yE'u oW c cs <br /> Will this project effect wetlands? ❑ Yes A 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 ❑ Soils(NRCS Maps) 0 Wetland Delineation(attach report) 13 Other <br />