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D!►AfTMENT Of /, NA•02670.04 <br />tINATURAIL <br />hr''T� ,% V w/R!v 4/at <br />RlSOURCEf <br />LOCAL UNIT OF (GOVERNMENT COMMENTS <br />Uon I (To be completed by applicant) PART e <br />N me of Applicant Address (Street. RFD <br />Ouarter Section(s) Sechor((s) Townships) <br />PROJECT LOCATION 1t- if <br />ro t affect (name a of lake, wetland. or watercourse) <br />nk •jE-, 4L A, <br />I hereby submit this application for permit to <br />(mark proper box) <br />00pprop►iata water 0 work in protected waters <br />Sectpn 11 (Ter bs completed b loyal nit I <br />No. City. State, Zip Code) I <br />O/Aj " *Y#9/) , UJkt f ''), MN <br />a 3LA) INf.Al". S4: <br />�Ignaf e o Iic a&4 Date 1 <br />r <br />y u o 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 N DAYS.) Water Appropriation Permit Applications are to be sent to the Central M-- <br />lice, St. Paul, and Protected Waters Permit Applications to the DNR Regional Office SEE REVERSE SIDE FOR CORRECT <br />MAILING ADDRESSES) <br />r <br />Was the W^posed protect f'" rnapected by this local unit of governmo �NO [] re <br />YES (it Yes give vwe. s name) <br />V fever a Name _ r_e <br />Authorized Stgnoture <br />le Date Teieprx-n! No (Area CoM <br />Name of responding So11 and Watw Cor4wv~ Dfstrtat, Wetersffed Otatrict. City or County <br />Address lot ter afsow narnetl Local untt 0f QOvernnwrnp _ --- -- -------____.—_. <br />(L►NA 0iv0e100 of Waters addresser Can back <br />