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NA-02622-02 <br />Rev. 12/81 <br />Sf'OEPAftTMfNT OF <br />NATURAL RESOURCES <br />PERMIT APPLICATION <br />TO WORK IN PROTECTED WATERS OR WHIANOS <br />liRCunmc OM sAFmi <br />D <br />PARTIL *. / <br />► ► Please read instriKtions before attempting to complete this application <br />H25IIp'A 'Nb <br />USE ONLY <br />irkr-iaa/toi <br />□swco nc/c <br />□wD nuscoe <br />Applicanj^s Name (Last. First, M.l.)Authorized Agent (if applicable) <br />Address (Street. RFO, Box Number. City, State. Zip Code) <br />i2b- g-ntm <;iov’ <br />Quarter SectiQn(s) <br />Telephone Numbers area cooi <br />( ) '/ 7 / > ^ '•■’'7 <br />Government Lot(s) <br />N(P r iJi <br />Fire No., Box No. or Project Address <br />Sections(s) <br />'A> <br />1 <br />Township(s) <br />//7 <br />j County . ^ <br />//tr^uiepi kn <br />H. PROPOSED PROJECT <br />Range(s) <br />2.3 .Tracts E.FHC, <br />Project will affect Lake. Wetland or watercourse <br />lake to//kc^ <br />□ fill JB excavate <br />□ drain □ construct <br />□ remove □ other (specify) <br />□ abandon <br />□ install <br />IV. ESTMATTO PROJECT COH <br />III. PROJECT AREA <br />□ dam <br />□ lake <br />□ wharf <br />□ bridge <br />□ harbor <br />□ riprap <br />□ channel <br />□ culvert <br />□ wetland <br />□ shoreline <br />□ obstruction <br />□ watercourse <br />□ sand blanket <br />□ permanent dock <br />qW(s^ify)‘ : 'j <br />i ' * M <br />--i <br />./II- i /i'c‘» <br />^ r /ifi, a H C / f J <br />■HEF EXflAIATION OF PROJECT . <br />y& -ft. of s J)C J ^ J.ctvii -t o <br />j-p y\t<CSi^^ry o.d'J cft\^n t c n c-i'n<-( <br />JUSTmCATiON (Explam why this project is needed) 7> ‘ ‘ 17*777 it_• <>» u♦» j/;i•</ m to (ie At7 <br />f) ^ Jt ^ a o S ! C $f ( /C'*' ! t\ ^ i H Z ^ ‘ ^ ^ (t i ^ f / n ft 4,t'' / / <* t/v 3 O- R| ^ / A CC. n / i p%,\% <br />t i ' i 9 / "T At ^ / '• .J" 10 ^ t t . *op »’-//. T thtf yclAttvrU tJi^ <br />■> 0. J h m/if-crC, tr.~tc f A(-> /«.' A'- / A» », -f A t' 1' ►‘■•A.j' (Kho f.'t'.- r^e <-v.*//. <br />c i ftx.i tr< tl-iii if- het.jht <br /><t*»n f.'k ’F “ >*‘iS f h ly h --.•■a ■ «• c» ♦>- * r’li-'i '■■fi <br />ENVIRONMEIfTAL IMPACT (Anticipated changes to the water and related land resources, including unavoidable but detrimental ehects) <br />J /ii-jx //»ii.h \.y, //.,/< T. <br />fre y'i <br />f • <br />/ « f J\ t 0\ if <br />C./&xnt\ *^h/Jy'h fc' 1,0,1 ,,yS <br />/a. tv',t cj i o J a Kt‘ ^ ,t .\'{a Ait ttifii • Oft: <br />Aj 7/ t t^sti\K4/ c t' /a‘V//I T• 77i c <br />let < t / r t J y /> <, f i 1) I % t yfc> of f'l'i iJ'>'} tKfff', »>c <br />ALTERNATIVES (Other alternatives to the action proposed) . . , . . <br />pj C t\ \ iUc^'t T I'-k'c uy C- ( ‘ ^ *’Atf, M t-1> f 1 he-ve J’Zooit^'/ ;■ A •£ <br />St <br />t’yf) <br />tc <br />KS <br />7 <br />/<•/.'»• c i&i/tr cn 11\! ^ pfcpCt iy I' J ck. e/f S o/«t' <br />C /1'< i ...y (o *>■> p hi c f y // ..j .4 jc *-//./ <br />I heretiy make applicalion purwtant to MinnesoU Statutes Chapter 105 42 and all supporting rules lor a permit to •ork in or sRect R«c above named proieciod <br />«aief($) in accordance with an supporting maps, plans, and other inhirmation submitted with this ^Icabon The inlormation tubnmd and statements made <br />concerning this application are true and correct to the best of my knowledgo. <br />STATE OF <br />COUNTY OF <br />AL< >T fT>a jt ,M. <br />e_A <br />Subscribod and sworn to before me this <br />^ 3 day of to 3 S' <br />Signature ol Owner or AplhorUed Agent ^ <br />O- c ff/u-t eft (Ir~- <br />Data <br />-I,?- rs <br />Signature of Data <br />My commission expves ^ ^ / 7 <5' 7 <br />Distribution: <br />White; ONR <br />Blue: SWCO <br />Green: Watershed District <br />Goldonrod City or County <br />Pink; Army Corps of Engineers <br />Canary: Applicant