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NA-01566-03 <br />DI~PAI~I'MENT OF <br /> <br /> NAT UI~A I- IIE$OURCI~$ <br /> <br />INSTRUCTIONS: <br /> <br />iName oF Lake(s) <br /> <br /> APPI ICAT!ON FOR PER 4IT <br /> l'O 'iNSTALL AND OPERATE <br />AN AERATION SYSTE I IN PUBLIC WATERS <br /> <br /> 1. Please T~e or Prin~ wi~h a ball,point pen when completing this application. <br />2. Mail your completed application io the ~partment of Natural Resources, Regional <br /> Fisheries Supervisor, located at the address to the right of the box marked below. <br /> []]]] 2115 Birch~nt Beac)~ Road NoE., Bemidjt, Minnesota 56601 <br /> [-1 120l East Highway 2= Grand Rapids, Minnesota 55744 <br /> f-'l 424 Front Street, Bux GU, Brainerd, Minnesota 56401 <br /> []] Box 756, Highway 15 South, NM Ulm, Minnesota 56073 <br /> ~ 2300 Silver Creek R~ad N.E~, Rochester, Minnesota 55904 <br /> []]] 12DO Warner ~oad, Sic~ Paul, Minnesota 55106 <br /> .... L~unty([es) lownsh[P I RangeI <br /> <br />Section[s) <br /> <br />Name of Person and Organkzat~,on (~ applicabl,,) ~equest~ng Permit <br /> <br />Ilelephone Number <br /> ( ) <br /> <br />Complete Makllng Address (No. ~ Street, RFD, :)ox No., Ckty, State, E, Zip Code) <br /> <br />Name oF Operator or Contact Person <br /> <br />The:purpose oF Installation is for: <br /> <br />Address <br /> <br />Telephone Number <br />( ) <br /> <br />Locatlon of System: <br /> <br />(d~.~scri. be locati, on on l~k~. and attach a'sketch) <br /> <br />Description o__[~stem: (provide al] pertine~t information including, but not 1½m½ted to, brand name oF system, <br />number and type of di~Fusers, ~kr capaci, ty cf b!owers or compressors, skze and capacity oF water pumps, length <br />of akr or water lines, depth oF diffusers, etc~) <br /> <br />Will equipment such as ~ir lines and diffusers be left in the lake as a permanent installation? ..................... r'"l YES ~ <br /> <br /> <br />