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i <br /> Project Name and/or Number: 3010 Somerset Lane,Orono-AE 14671 <br /> � PART ONE: Applicant Information <br /> If applicant is an entity(company,government entity, partnership,etc.),an authorized contact person must be identified. If the <br /> applicant is using an agent(consultant, lawyer,or other third party)and has authorized them to act on their behalf,the agent's <br /> contact information must also be provided. <br /> Applicant/Landowner Name: Patrick Butler <br /> �' ` ' �� <br /> Mailing Address: 3010 Somerset Lane,Orono,MN 55356 `' f ��17 <br /> Phone: 904-393-6695 <br /> E-mail Address: butlerjillpat@aol.com C0� �F ����'��O <br /> Authorized Contact(do not complete if same as above): <br /> Mailing Address: <br /> Phone: <br /> E-mail Address: <br /> Agent Name: Ben Hodapp—Anderson Engineering <br /> Mailing Address: 13605 15L Avenue North,Suite 100, Plymouth, MN 55441 <br /> Phone: 763-412-4000 <br /> E-mail Address: bhodapp@ae-mn.com <br /> PART TWO: Site Location Information <br /> County: Hennepin City/Township: Orono <br /> Parcel ID and/or Address: 053-0411�23220029,3010 Somerset Lane <br /> Legal Description(Section,Township,Range): Sec.04,Twp. 117N,R.23W <br /> Lat/Long(decimal degrees): 44°58'30.82"N,93°35'S8.24"W <br /> Attach a map showing the location of the site in relation to local streets,roads,highways. <br /> Approximate size of site(acres)o�if a linear project,length(feet): 3.45 acres <br /> If you know that your proposal will require an individual Permit from the U.S.Army Corps of Engineers,you must provide the <br /> names and addresses of all property owners adjacent to the project site. This information may be provided by attaching a list to <br /> your application or by using block 25 of the Application for Department of the Army permit which can be obtained at: <br /> http://www.mvp.usace.armv.mil/Portalsl57/docs/re�ulatory/Re�ulatoryDocs/enaform 4345 2012oct.pdf <br /> PART THREE: General Project/Site Information <br /> If this apptication is related to a delineation approval,exemption determination,jurisdictional determination,or other <br /> correspondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. <br /> Describe the project that is being proposed,the project purpose and need,and schedule for implementation and completion.The <br /> project description must fully describe the nature and scope of the proposed activity including a description of all project elements <br /> that effect aquatic resources(wetland,lake,tributary,etc.)and must also include plans and cross section or profile drawings <br /> showing the location,character,and dimensions of all proposed activities and aquatic resource impacts. <br /> See Level 1 Wetland Tech Memo. <br /> Minnesota Interagency Water Resource Application Form February 2014 Page 3 of 6 <br />