Wetland Delineation Report (2) - Laserfiche WebLink

Home Browse Search

Project Name and/or Number: 1795 Fox Street Joint Application Form for Activities Affecting Water Resources in Minnesota PART ONE: Applicant Information If applicant is an entity(company,government entity,partnership,etc.),an authorized contact person must be identified. If the applicant is using an agent(consultant,lawyer,or other third party)and has authorized them to act on their behalf,the agent's contact information must also be provided. Project Name: 1795 Fox Street Applicant/Landowner Name: Thomas Hamilton Mailing Address: 1795 Fox Street,Orono,MN 55391 Phone: E-mail Address: tom.hamilton'a;ictg.com Authorized Contact(do not complete if same as above): Pat Dorn,Patrick Dorn Construction Mailing Address: 19165 81st Place North,Maple Grove,MN 5531 Phone: (612)801-6453 E-mail Address: pat ci-pdcmn.com Agent Name: Rob Bouta,Kjolhaug Environmental Services Co. Mailing Address: 2500 Shadywood Road,Suite 130,Orono,MN 55331 Phone: (612)581-0546 E-mail Address: RobB a kjolhau<_Lenv.com PART TWO: Site Location Information County: Hennepin County City/Township: City of Orono Parcel ID and/or Address: PID 03-117-23-44-0006 Address: 1795 Fox Street,Orono,MN 55391 Legal Description(Section,Township,Range): SW 1/4 Sec.3 and NW 1/4 Sec. 10,TI I 7N,R23W Lat/Long(decimal degrees): 44.964367,-93.567281 Attach a map showing the location of the site in relation to local streets,roads,highways. See attached. Approximate size of site(acres)or if a linear project,length(feet): 28.22 acres If you know that your proposal will require an individual Permit from the U.S.Army Corps of Engineers,you must provide the names and addresses of all property owners adjacent to the project site. This information may be provided by attaching a list to your application or by using block 25 of the Application for Department of the Army permit which can be obtained at: http://www.mvp.usace.army.mil/Portals/57/docs/regulatory/ReguiatoryDocs/engform 4345 2012oct.pdf PART THREE: General Project/Site Information If this application is related to a delineation approval,exemption determination,jurisdictional determination,or other correspondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. Describe the project that is being proposed,the project purpose and need,and schedule for implementation and completion.The project description must fully describe the nature and scope of the proposed activity including a description of all project elements that effect aquatic resources(wetland, lake,tributary,etc.)and must also include plans and cross section or profile drawings showing the location,character,and dimensions of all proposed activities and aquatic resource impacts. A new home is proposed for construction on the site. Minnesota Interagency Water Resource Application Form February 2014 Page 1 of 3