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• Til£ OB.'tCTIVES OF TOE V.ORK for Vihich a permit is sought are: <br />^xr^. A1/n-Tdr 'M ijr'Ar P/.J/-M07 <br />[/r~vr.z=-^J!> D-* 'TpP <br />L/9^at XX! tx/>'/£Td^jKA 7)i/^P^ 7^/7 P L77J:z <br />/.Ai * / A /h uJA?D '^■R.o ^A. APPPo <br />'I <br />0 <br />THE FOLLOVHNO SUPPLEMENTARY DATA IS ATTACHh.O: (Check applicable sections beloiv. ) <br />I ] Sketch (~1 Topographic map (73 Cross Sections i 1 Sound Sngs (73 Letter <br />3piat (□Plan (□Profile (□Boring logs (□Air photo <br />pother (specify) <br />The applicant declares that the information submitted'herewith and the stateirients made <br />herein are a true and correct representation of the facts, and that the filing of this <br />application and infoimation with the Conmissicner of Conservation is prime facie evidence <br />of the correctness thereof. <br />Dated this^^ day of 4.------- <br />Applicant ^ <br />IPriBW>r tjpe <br />Signed <br />irrlBU^ tjpe si <br />N- — <br />lUtUI <br />Address 3t\4. C/ort^a^ Jk.u^ <br />f <br />State of Minnesota ) <br />County of _ _j <br />^ ^ VOn thisJT-" —day of <br />AFFIDAVIT j <br />%' <br />A.D. 19/f^ before me personally appeared <br />/^- A/^ <br />Si. "x_ V.* *V_ / w <br />ii <br />\ <br />h <br />who being first duly sv/orn and to me kncj to be the person^s__who executed the foregoing <br />application, acknowledge (a) that>^^ executed the same BS_^a_ own free act and deed and <br />that the statements, maps, plans, documents, and other supporting data are true and correct <br />according to best knowledge and belief. <br />i <br />s Notary Public <br />Kj Co.T.mLf^"' L'.p“eJ ‘1 It. <br />U(y commission expires_________________ 19 <br />i. County <br />r • / <br />'Cl V' ‘ <br />!tr <br />]• . <br />jj^(Attac^MxPs, plans and other items checked olfve.j