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N®TE: This Permit only applies in the following Counties: Anoka, Carver, Dakota, <br />Hennepin, Ramsey, Scott and Washington <br />General Permit 2000-6117 requires that the Department be notified five days before the start of any <br />temporary water appropriations covered by that permit. Please fill in the items listed below and fax this <br />form to the Area Hydrologist at 651-772-7977. The form can be mailed to DNR Waters, 1200 Warner <br />Road, St. Paul, MN 55106. You can also call the Area Hydrologist (651-772-7910) and provide the <br />information requested on this form. <br />Applicant Name: <br />Contact Person: <br />Address:. <br />City/State/Zip Code: <br />Telephone: <br />General Pro,j~ect Description <br />Name (of basin, flooded area, or pond): <br />Describe purpose of project: <br />DNR ID ~ (If applicable) <br />Current Basin and Receiving Basin Water Surface Elevations: <br />Basin OHW elevation (if known) or Proposed Elevation of water at end of project: <br />FAX: <br />(Over Pleaase) <br />