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Project Name and/or Number: 1205&1225 Shoreline Drive <br /> PART FOUR: Aquatic Resource Impact1 Summary <br /> If your proposed pro)ect involves a direct or indirect lmpact 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 vfew map, <br /> aerial photo,and/or drawing showing ail of the aquatic 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 /> Aquatic Extsting Plant <br /> Aquatic Resource (fill,excavate, Impact Overall Stze of Watershed#, <br /> Resource Type Community <br /> ID(as noted on drain,or Permanent(P) Size of Impactz Aquatic and Bank <br /> overhead view) (Wetland,lake, remove or Temporary Resource 3 Type(s)in Service Area# <br /> tributary etc.) impact Area° <br /> vegetation) (T)1 of Impact Areas <br /> ilf impacts are temporary;enter the duration of the impacts in days next to the"T". For example,a project with a temporary access fill that <br /> would be removed after 220 days would be entered"T(220)". <br /> ilmpacts 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 in linear feet of impact and an area of impact by indicating first the Nnear feet of impact <br /> along the flowllne 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 exemptfon under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". <br /> 4Use Wetland Plants and Plant Community Types of Mlnnesota and Wisconsln 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 FIVE: Applicant Signature <br /> ❑ Check here if you are requesting a ure-annlication consultation with the Corps and LGU based on the information you have <br /> provided, Regulatory entities will not initiate a formal application review if this box is checked. <br /> By signature below,I at the information in this application is complete and accurate. i further attest that I possess the <br /> authorl e the wo esc herein. <br /> ���- � � <br /> e,.' �"^ �t - h '9V.�d. 'i �,�-� <br /> Signature , � � '�°� `�ate: "� �- <br /> I hereby authoriz to a n behalf my age t in the processing of this appllcation and to furnish,upon request, <br /> uppleme al i format n in support of this application. <br /> i The term"impact"as used tn this jofnt appiicatton form is a generic term used for disclosure purposes to identify <br /> activities that may require approval from one or more regulatory agencies. For purposes of this form it 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 />