Laserfiche WebLink
` DEPARTMENi Of • ���,% /J���� � NA-02670-06 <br /> ' G�.�' ,. <br /> 0l7��5�4Q ` Rev.7/50 <br /> ' �NATURAL RESOURCES �' <br /> LOCAL UNIT OF GOVERNMENT COMMENTS pART B <br /> Section t (To be completed by applicant) <br /> Name of Applicant Address (Street, RFD, Box No., City, State, Zip Code) � <br /> Quarter Section(s) Section(s) Township(s) Range(s) County(ies) <br /> PROJECT LOCATION <br /> Project will affect: (name and number of lake, wetland, or watercourse) <br /> I hereby submit this application for permit to: Signature of Applicant Date <br /> (rnark proper box) �f <br /> X - ,....�.�!"P_...e%�'...-�'<i d.'�--L �d��. <br /> �appropriate water �work in protected waters � <br /> --•�---—------------------------------------------------- <br /> Section II (To be completed by local unit ol government) <br /> The following local unit of government comments and/or recommendations are submitted for consideration by the <br /> Department of Natural Resources in the disposition of the referenced permit application. (YOUR RESPONSE MUST BE <br /> SUBMITTED TO THE DNR WITHIN 30 DAYS.)Water Appropriation Permit Applications and Protected Waters Permit <br /> Applications are to be sent to the DNR Regional Office.SEE REVERSE SIDE FOR CORRECT MAILING ADDRESSES). <br /> Was the proposed project field inspected by this local unit of government? ❑NO �YES (if Yes, give viewer's name) <br /> Viewer�s Name Title <br /> Authorized Signature Title Date Telephone No.(Area Code) <br /> � ) — <br /> Name of responding Soll and Weter Conservetlon Dlstrlct, Watershed District, City or County <br /> Address (of the above nemed local unit of government) <br /> (DNR-Division of Waters addresses on back) <br />