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DNR Permit
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Applicant's Name (First, MI, Last)
Day Time Phone Number
Cell Phone Number
Lake Home Address (# and Street, RFD, Box #, City, State, Zip Code)
Lake Residence Phone Number
Permanent Mailing Address (Indicate if it is the same as above)
E-mail Address
My property extends ft along shore.
Proposed treatment area extends ft along shore by ft lakeward, out to a depth of ft.
Width extending to open water: ft in width extending to open water.
Include a north arrow, house location, shoreline, the treatment dimensions, the location of the dock, and the distance between the dock and the nearest adjacent property boundary or identifiable landmark.
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