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Project Name and/or Number: KES 2021-104 <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: Ethan Kindseth <br /> Mailing Address: 2500 Shadywood Road#750 <br /> Orono, MN 55331 <br /> Phone: 612-741-9069 <br /> E-mail Address: ethan@almahomesmn.com <br /> Authorized Contact(do not complete if same as above): <br /> Mailing Address: <br /> Phone: <br /> E-mail Address: <br /> Agent Name: Will Effertz <br /> Mailing Address: 2500 Shadywood Road#130,Orono MN 55331 <br /> Phone: 952-290-6340 <br /> E-mail Address: Will@kjolhaugenv.com <br /> • PART TWO: Site Location Information <br /> County: Hennepin City/Township: Orono <br /> Parcel ID and/or Address: 3211823340004 <br /> Legal Description(Section,Township,Range): S:32 T:118N R:23W <br /> Lat/Long(decimal degrees): <br /> Attach a map showing the location of the site in relation to local streets,roads,highways. <br /> Approximate size of site(acres)or if a linear project,length(feet): 39.7 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.army.mil/Portals/57/docs/regulatory/RegulatoryDocs/engform 4345 2012oct.pdf <br /> PART THREE: General Project/Site Information <br /> If this application 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 /> I <br /> Minnesota Interagency Water Resource Application Form February 2014 Page 3 of 5 <br />