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isi PERMIT APPLICATION PART A OFFICE USE ONLY.
<br /> DE PA R TM E N T o F TO WOHK IN PROTECTED WATERS OR WETUNDS P. . N0.
<br /> �"�����`a (INCLUDIN6 DAM SAFETII) f
<br /> NATURAL RESOURCES
<br /> 0 SWCD 0 C/C
<br /> ►►Please read instructions before attempting to complete this application. �W�D. �USCOE �
<br /> I. Applicant's Name (Last, First, M.l.) Authorized Agent (if applicable) Telephone Number&a�eac
<br /> Nennepin County (6�2 )935-33�31 �
<br /> Address (Street, RFD, Box Number, Ciry, State, Zip Code)
<br /> 320 fdashington Avenue South, ftogklns, �ffnnesota, 55343
<br /> Government Lot(s) Quarter Section(s) Sections(s) Township(s) Range(s) Lot, Block, Sub-Division
<br /> 3 5E 1/4 7 117 23
<br /> Fire No., Box No. or Project Address County Project will affect Lake,Wetland or Watercourse
<br /> �t�!!l�R�t) � f knownj mber, L�ke Mtke I7-23�i>
<br /> II. PROPOSED PROJECT III. PROJECT AREA
<br /> ❑ fill �](excavate ❑ dam ❑ culvert ❑ shore-protection
<br /> ; ❑ drain ❑ construct ❑ lake ❑ wetland ❑ other (specify)
<br /> o remove ❑ other (specify) ❑ wharf ❑ shoreline (}�dtr CSAN 1�3 Brid,�� on
<br /> ❑ abandon ❑ bridge ❑ obstruction �8n��� ��t�eer+ Fctrest
<br /> ❑ install ❑ harbor ❑ watercourse Lake ans# E�est Ar�.
<br /> IV. ESTIMATED PROJECT COST ❑ riprap ❑ sand blanket
<br /> $ �1 channel ❑ permanent dock
<br /> ` V. BRIEF EXPLANATION OF PROJECT
<br /> Excavate under the bridge alor�g bath siQes c►f the chanr�el whert the� dEpth has becos� 2.5•
<br /> to 3.0' in areas wh�re boats pass. The depth will t� txcavated to 6` anc! about IAt? cubic
<br /> yar�,saf �aterial �rill b� remaYed.
<br /> VI. JUSTIFICATION (Explain why this project is needed)
<br /> This pork is required sa that Contractar•s equip�ent caa obtatn access to Forest Lake
<br />�' Chann�l for a riprap pro�ect. lilso. additional channel depth af�i be r�qatred for r�c-
<br /> �reaLional boat �assage.
<br /> YII. ENVIRONMENTAL IMPACT (Anticipated changes to the water and related land resources, including unavoidable but detrimental effects)
<br /> M1nor turbulance during excavatian. tit� �et^raartent icap�ct.
<br />�
<br /> VIII. ALTERNATIVES (Other alternatives to the action proposed) �f
<br /> None.
<br />��
<br /> �X I hereby make application pursuant to Minnesota Statutes Chapter 105.42 and all supporting rules for a permit to work in or affect the above named protected
<br /> water(s)in accordance with all supporting maps,plans,and other information submitted with this application.The information submitted and statements made
<br /> concerning this application are true and correct to the best of my knowledge.
<br /> ,,- ;' Signature�of Owner or Authorized Agent: f,-" Date
<br /> STATE OF r' i/ - � ��,�� ' � �, �,. ,�
<br /> �'' ��..
<br /> ` Signaxure of Leasee Date '
<br /> COUNTY OF �`j�� � ' `'�
<br /> Subscribed and sworn to before me this
<br /> Distribution:
<br />�.. �� day of � � 19� � �ti �^��-�,�,�,,, . _, White: DNR
<br /> �^�- ._�
<br /> `�" bo►vatv,� �n,��, r�cE",.�f�.. Blue: SWCD
<br /> �w� � s Green: Watershed District
<br /> My commission expires �` ' � �`j�;� hOTARY P�Ig«�r,qfp�;JtSGTA
<br /> < "�1-' HEPdNEp�M CeU;�TY ~ Goldenrod� City or County `
<br /> Signature of Notary � MY Commission Ex ires Jan 15, ` `
<br /> ,,�,� p 198g � Pink: Army Corps of Engineers �
<br /> ,.� r „�!., . �� ,u, ,:; _ �w�,v�.v� Canary: Applicant
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