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a <br />DEPARTMENT OF <br />DOCES07A <br />NATURAL RESOURCES <br />Section I (To be completed by applicant) <br />NA-02670-04 <br />Rev. 4181 <br />LOCt'\L UNIT OF GOVERNMENT COMMENTS <br />PART B <br />Nam, of Applicant Address (Street, RFD. Box No.. City, State, Zip Code) <br />p <br />Quaker Sections) Sections) Townships) Ranges) County(ies) <br />PROJECT LOCATION Sw 1 Z a Y a3 R <br />Project will affect: (name and number of lake, wetland, or watercourse) <br />>4 <br />I hereby submit this application for permit to: <br />(mark proper box) <br />[] appropriate water work in protected waters <br />Signature of Applicant Date <br />Section Il (To be completed by local unit of 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 Apr_li.atlons are to bP 3ent to the Central Of - <br />Ice, St. Paul, and Protected Waters Permit Applications to the DNR Regional Office. SEE REVERSE SIDE FOR CORRECT <br />MAILING ADDRESSES). <br />-+t4 Gt' Gb c; T- Q9 CC" r t 0-- f <br />�� .6'CC�S.•! G� �-P T'-�'C-' LQvo..'Go it G�`''��lio/ .�i�iCfi"4� � � L� <br />Authorized Signature <br />Title <br />Date <br />Telephone Code_) <br />// <br />,�(Area <br />LLNo. <br />Name of responding Soil and Water Conservation District, Watershed District, City or County <br />