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approflUU ipacu Mow » Wow. Ploaio dwdtIho <br />«.«Tfwiwre you ofo tending m« form. Ktir»mttr u kttp • mpy Or yair ncordt. <br />“I? *•“''>= ■=««»• ^ wotoirtod monogemem orgonladon. <br />Speofy th. LGU t. wNeh yon tendln, m. fonn: HinnnhVhn rr.fy Uintnnrhnd pist^ct <br />~— OmwcT Of one eidsti for the projea area). <br />Specify tns Wittfsh^d District s HinnEhdhd Cr66k Wdt6rsh6d Distrlct <br />X ^ ~ <br />------ MamcsoTA DcPAimierT of N atural Raounca (MONR) retfonal office <br />JL_ U.S. A amv CORFS OF Enoww (a COE). Send the ACOE copy to: <br />S'TiSfT^r',1; m '??,S57g. <br />UMAtan*rI?'”n " '*•'"’"'polmlon., Indudhg <br />owrMy ...d th. fdlowing InfmmrtSIS?",! wl^rf MeSS. <br />iiiiiiiiiiiiiiiiixnixminimiiiiiiminiimiTTTTTTTTTT^Yi' <br />* «»'y «»««•".whh««d;:;S!?rpr.VdT«jr*.jr.:; s;j;. „ <br />SiQnatufe of Applicant • *'■'* Signature of Agent Date <br />*IO^d by the person who deaira to undertake the proposed activity (appHant) or It <br />may be dgnad by a duly authorind ag«n If tha Informadon raduoatad below b^otdda* * “ <br />Klsev%A «eM#4Agent's Name and tide: <br />Agent's address: <br />Agent's telephone: ( <br />§gg ATTACHMENT ABQUT MDNR PERMIT Pgl=g