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Pumping Details <br />Point of Taking: <br />1/4 1/4 <br />PID# (If known) <br />Estimated Pumping Rate <br />County: <br />City: <br />1/4, Section ,Township ,Range <br />gallons per minute <br />Estimated Volume of Water to be Appropriated: <br />Start of Pumping (date): <br />Point of discharge: <br />1/4 Il4 <br />PID# (]f known) <br />Receiving Water (name and DNR ID # if applicable): <br />[ ] Stormsewer [ ]Basin [ ]Other (describe <br />Approval (if required) has been received from the appropriate authorities for the proposed temporary <br />appropriation: [ )Watershed Management Organization [ ]County <br />[ ]Municipality [ ]Township [ ] WCA Authority <br />Date: <br />Applicant Signature <br />Area Hydrologist Authorization <br />[ ]See Attached Additional Conditions <br />Date: <br />FAX or mail this form and a map indicating the pump site and discharge location to the Area Hydrologist at least <br />five working days before the start of pumping. Provided that the Area Hydrologist did receive this notification at <br />least five working days in advance, pumping may commence as planned unless the applicant is notified by the <br />DNR to await further review. <br />c: Watershed Management Organization <br />County Soil and Water Conservation District <br />City <br />Area Conservation Officer <br />DNR Central Waters: Appropriation Permits, SWUDS <br />gallons <br />End of Pumping (date): <br />1/4, Section ,Township ,Range <br />