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ATTACHMENTS: • <br /> • Site Survey <br /> • Soils map <br /> • Pictures with photo reference points for monitoring purposes. <br /> • Evidence of ownership of area. <br /> The deed restriction form will be to follow if we gain the permit. <br /> III. SPECIAL CONSIDERATIONS <br /> To the best of the applicant's knowledge, are any of the following factors applicable to the <br /> affected site? Whether present or not indicated as follows: (I)mpact sites, (R)eplacement sites, <br /> (B)oth, (N)iether. <br /> • Federal or state-listed endangered species N <br /> • Rare natural communities N <br /> • Special fish and wildlife resources including: <br /> fish passage and spawning areas N <br /> colonial waerfowl nesting colonies N <br /> migratory waterfowl concentration areas N <br /> deer wintering areas N <br /> wildlife travel corridors N <br /> • Archaeological or historic sites N • <br /> • Ground water sensitive areas N <br /> • Sensitive surface waters (e.g. DNR designated trout waters) N <br /> • Educational or research sites N <br /> • Waste disposal sites N <br /> • Is the project consistent with local plans (e.g. watershed <br /> management plan use plans, zoning and master plans?) B <br /> IV. SWORN STATEMENTS <br /> • I Sherri Ruf confirm by signature below that: <br /> (I) the banking wetland was not previously restored or created under a prior approved <br /> replacement plan; and <br /> (ii) the banking wetland was not drained or filled under an exemption during the previous ten <br /> years; AND <br /> (iii) the baking wetland was not restored with financial assistance from public conservation <br /> program; AND <br /> (iv) the banking wetland was not restored using private funds other than those of the <br /> landowner unless the funds are paid back with interest to the individual or organization that 1111 <br />