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Project Name and/or Number: 1205&1225 Shoreline Drive <br /> PART FOUR: Aquatic Resource Impact1 Summary <br /> If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each <br /> impact in the table below.Include all anticipated impacts,including those expected to be temporary.Attach an overhead view map, <br /> aerfal photo,and/or drawing showing all of the aquat(c resources in the project area and the location{s)of the proposed impacts. <br /> Label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. <br /> Type of Impact Duration of County,Major <br /> A Aquatic Im act Overall Size of Existing Plant Watershed# <br /> quatic Resource (fill,excavate, p , <br /> Resource Type Community <br /> ID(as noted on drain,or Permanent(P) Size of Impact2 Aquattc and Bank <br /> (wetland,lake, Type(s)in <br /> overhead view) tributary etc.) remove or Temporary Resource 3 Impact Area° Service Area# <br /> vegetation) (T) of Impact Area <br /> llf impacts are temporary;enter the duration of the impacts in days next to the"T". For example,a project with a temporary access ffll that <br /> wouid be removed after 220 days would be entered"T(220)". <br /> 2lmpacts less than 0.01 acre should be reported in square feet. Impacts 0.01 acre or greater should be reported as acres and rounded to the <br /> nearest 0.01 acre. Tributary impacts must be reported fn Ilnear feet of impact and an area of impact by indicating first the Iinear feet of fmpact <br /> along the flowline of the stream followed by the area impact In parentheses). For example,a project that impacts 50 feet of a stream that is 6 <br /> feet wide would be reported as 50 ft(300 square feet). <br /> 3This is generally only applicable if you are applying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". <br /> 4Use Wet/and Plants and P/an[CommunJty Types of M/nnesota and Wlsconsln 3"�Ed.as modified in MN Rules 8420.0405 Subp.2. <br /> SRefer to Major Watershed and Bank Service Area maps in MN Rules 8420.0522 Subp.7. � <br /> If any of the above identified impacts have already occurred,identify which impacts they are and the circumstances associated <br /> with each: <br /> No impacts have occurred to date. <br /> PART FlVE: Appiicant Signature <br /> ❑ Check here if you are requesting a�re-an lication consultation with the Corps and LGU based on the information you have <br /> provided. Regulatory entitfes will not initiate a formal application review if this box is checked. <br /> ey signature below,I attest that the information in this application fs complete and accurate. I further attest that I possess the <br /> authority to undertake the work described herein. <br /> . t <br /> __. _. ,: � <br /> . � <br /> � � <br /> .,� <br /> �: . <br /> Slgnature: ,�; . � ; . : �: � � Date: <br /> i hereby authorize to act on my behalf as my agent in the processing of this application and to furnish,upon request, <br /> supplemental informatfon in support of this application. <br /> 1 The term"impact"as used in thts jotnt appltcatton form is a generic term used for disclosure purposes to ldentify <br /> activtties that may requt�e approval from one or more regulatory agencies. For purposes of this form tt is not meant to <br /> indicate whether or not those activities may require mitigation/replacement. <br /> Minnesota Interagency Water Resource Application Form February 2014 Page 4 of 5 <br />