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� P�aject Name anc#/or�Fumber: �t114-(}22-fl3 ' <br /> � €�ART Ft�UR; Aquat�c R�sarurce Im�act� Sumr�tary � <br /> ff your propc���d prcrj�ct ir�votves a dir�ct ar indirect impact to ae� �q��tic resouree (viretianclF laice, tributary, etc.) identify each <br /> impact in the tabie b��ow. Inckude a{I a�ntieipated impacts, includin�thQse ��p ed ta b�t�mporaRa. Attach an overhead view � <br /> map, aeriai ph+�t�, �r��/�r drawing shov�ring alt of the aqu�tic resources in t�e �rt�jec� �r�a and th� location(s) of the psoposed <br /> ��pa���,�,abe{���p��qu�t��resource on fhe map with a reference numb�r or 1�tt�r�nd id�rttify the impacts in the fatlowing table. <br /> ��_��_ Type of Impact Duration of ��� -�---� County,Ma�or � <br /> Aquatk �istins�Plant { <br /> Aquatic Resaurce� (fiil,excavate, tn►padt �Ctver�ii Sizs a# Watershed�, <br /> �� �Resource Type a� Catnmunity ; <br /> IO(as noted an drain,or Permanent(P� Size aflmpact I At#uatic and Bank <br /> (wetland,lake, r�mr�ve or Ternporary I Resourcc� �Y1��s}`sn � Sen+ice Area# <br /> � averhead vfewj ir�rrpact Area � ; <br /> trib�tary ete.) � c�€lm��ct Area � <br /> v�$eeaa�#or�} tT} , <br /> ` VLfetland 2 Wetlaad Rentsau� �'{18C�) 0.2 acre N/A �'ype2 ktV�tl�r�d 20/7 � <br /> i <br /> vegetati�n i1��:adnw ' <br /> _.� � I <br /> ; ', � <br /> itf dmp��s are�temporary;arnter the duratton of the impacts in days nex't tcs ttva"T". far example,a project with a temparary acaess fii4 tEsat � <br /> uu�uid be removed after 220 ciays wauld be ente!ed"T(22Q�". � <br /> Flmpacts Iess then O.QI acre shouid be reported in square feet 1m�racts O.Ui acr�or greater shauld be reported as ac�es and rounded to the ; , <br /> nearest 0.41 acre. Tr1bu&ary impa�ts must kr�reparted in linear teet of impact a+nd an sr�a n#impact by inclicating first the linear fset of impact j j <br /> alany�tF►e fkowla�ae of the st rn foil€�wed by ths area irr+pact in parentheses). �or���+ple,a pro�ect that+rrepacts 50 feet of a sEream that is 6 ; � <br /> fe�t witfe wcauld b��epar�ed as S�Yt{30ft squaee feet). ' <br /> �This is generaiiy arsEy a��Sti��bEe if yoes arc applyin;tor a de mi�imis exemptiar�under MPi Ru�e�842Ct,C}4�0 5ubp.8,atherarise enter"N/A". ; <br /> , 4Uss Wsrtond Ptants rrncf�fant Cammuniry Types of fWnnesoto ond Wisconsdn 3`�Ed.as rn�#f' ics MF3 Ru1es 8420.04Q5 Subp.2. � <br /> SRefer to Major Wat�r�hed and Bank 5ervice Ar�a maps in MN Rules 842Q.0522 Su6p.7. <br /> , <br /> if arty of the a�crve ident��ed impa+cts have already ocwrrcd,identify which imp:�cts fih�y�re a�nd thc circumstances assac�ated � � <br /> with each: � ' <br /> I ' <br /> i <br /> ' : I <br /> � <br /> ������ P���' �1'VE: A���►licant Signature � <br /> � <br /> � Check here if you are requesting a pre-�p�slicati�r�c�ansultati�n wifih the Corps and lGU based on th�inf�►rmaticr�you have <br /> provided. Reguiatary entities wi3i not initiate a fesrrr���a�ap�icaticsn review ii this box is checked. <br /> �� <br /> By signature betaw,t attest that the inforrr�aticsc�i�this ap�kicaitnn is comptete and aucurate. t furth€r attest tt�at t possess th� <br /> , aukhority ta�undert Ic�ttte wo�Jc�crsts�c�:herein� <br /> F��-.i ^'�� ¢ ( 5 �"� <br /> . ; . 7. <br /> :, � tl � � I � R� 3 t t (i i ` ✓ � / � f <br /> w <br /> i {\ <br /> � {p y fy . ,� ( \ <br /> ���itj �,h� � { �p� . ���� � ,p. ` � � ,�, j" �".� f d <br /> Sfgriefure.� 6 � , .;� �F � �,._ _ t,�'� ' <br /> ; _� ,��w � <br /> !hereby�tu��iari��riar��V'it�to�cf an m�r bet�alf as my agent in the process�r��a�t���a�rp��c�Tion and to furnish,upan requesf, ; <br /> suppiemerftai infarmati4n in supparc of tFr�s a�sp#'s�ati<�n. <br /> ; <br /> i't'I�e term"emptet"as used in thfs jtsint applicati�xn#orm is a generec terrn used for disclosure purpas��t�identil�r <br /> att�rit#ts th�rt may requirt a�pproval fram orte�rr more r�ul�+tor�t agenc�es. For purpo�sirs of this fc�rm it is r�at mtant tc� <br /> ir�d��ate wheEher or not those activit�es m�yr r u�€e itig����n/repiacement. j <br /> ; � <br /> � M�nnesuta Interagency Water Resouree Appli�e�ti��s F�rrr�Fet�rc�ary 2014 P��5 crf 12 � <br />