HomeMy WebLinkAboutRiprap/Shore-line work - 02/15/1995 State of Wisconsin APPLICATION/PERMIT FOR RIPRAP PROJECTS
Department of Natural Resources PURSUANT TO SECTION 30.12(3)(a)3, WIS. STATS.
Form 3500 -91 Rev. 12 -93•
This form is required under section 30.12(3), Wis. Stats. Refusal to provide this information may result in the dismissal of your application. Personally
identifiable information on this form will be used for no other purpose.
Landowners Name Project Location
z jr T' �.riitmt'nw�t t r r r 1/4, 1/4, Section 1
Street or Route] East
2120 White 'Swan Drive T I N, R t West
City, State, Zip Code
Cis'akosct, WT 54901 Q City Town 0 Village of ‘j`y"",(N'''
Home Telephone Number Work Telephone Number County Waterway Lake
11. 231 �7F''s3 I s;tT f T lay r ..innnel off Wjnnebags
I hereby certify that the information contained herein is true and accurate. I am the owner of the riparian property or I am the duly authorized
representative and may sign this permit on behalf of the owner(s) of said property. I have read and understand all of the conditions of this permit listed on
the reverse side and will construct the above mentioned project in compliance with all such conditions. I understand that failure to comply with any or all
of the provisions of the permit renders the authorization contained herein null and void. I understand that failure to comply with the conditions of this
permit may result in a fine and /or imprisonment under the provisions of s. 30.13(5), Wis. Stats., or forfeiture under s. 30.15, Wis. Stats.
Printed or Typed Full Name of Applicant Signature of Applicant Date Signed
Dr, '.�z� <rt chaf.�nrUrt f° I2/15/95
FINDINGS OF FACT
1. The applicant has complied with all procedural and legal requirements of Wisconsin law.
2. The proposed project will not adversely affect water quality, will not increase water pollution in surface waters and will not cause environmental
pollution as defined in s. 144.01(3), Wis. Stats., if the project is constructed in accordance with this permit.
3. The Department has determined that the granting of this permit would not be a major state action significantly affecting the quality of the human
environment.
4. The Department and the applicant have completed all procedural requirements and the project as permitted will comply with all applicable requirements
of Wisconsin Administrative Code and Wisconsin Statutes.
CONCLUSIONS OF LAW
1. The Department has authority under applicable Wisconsin Administrative Codes and Wisconsin Statutes to issue a permit for this project.
2. The Department has complied with s. 1.11, Wis. Stats.
NOTICE OF APPEAL RIGHTS
If you believe that you have a right to challenge this decision, you should know that Wisconsin Administrative Codes and Wisconsin Statutes establish
time periods within which requests to review Department decisions must be filed.
To request a contested case hearing pursuant to s. 227.42, Wis. Stats., you have 30 days after the decision is mailed, or otherwise served by the Department
to serve a petition for hearing on the Secretary of the Department of Natural Resources. This notice is provided pursuant to s. 227.48(2), Wis. Stats.
LEAVE BLANK DEPARTMENT OF NATURAL RESOURCES USE ONLY
STATE OF WISCONSIN
DEPARTMENT OF NATURAL RESOURCES
For the Secretary
By
Title r' p r Date Signed
1:1444.4 �S/f�L
COUNTY ZONING ADMINISTRATOR'S COPY l /3�
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