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NA-02622-05 rr -T <br />R«v.12«1 <br />■^^MMITMINT OP <br />MATUIAl IlSOUtCfi <br />- J <br />« I <br />rarfryiHKnw <br />I rwifCTI#WIBB M •ETliM <br />^l0fTTI <br />I?-0^»CE use ONLY <br />PP JIO <br />w ► Pteas« f*^ad instructions before attemoting to complete tfns application <br />□swco ntc <br />Owo Gu*x:o€ <br />m. <br />Appi(C»it$ Mamc (Last. First. Ml) <br />Ao<kK> 0 <br />M^ess (Street. W <br />A. <br />ess (Street. hFO. Boi Nuin^. City. State, 2ip <br />Authorir«3 Agent (it apo'icaDte)Telepftone KlumOerAafeacoap <br />^2. ) v?/«f y 77 <br />C® <br />sa.^S39l <br />LOCATION PRO^SgD PROJECT (BdSURE TO INCLUDE SKETCH SHOWING HOW TQGET TO THE SITE) <br />Government Lot(s)Ojarter Section(s)Section(s) Mo <br />Fire No. Box No or Protect Addr <br />/94/ <br />IX No or Profoct Addrm <br />TYPE OF WORK PROPOSED (CHECK ONE} <br />To«nsliip(s) No <br />County <br />Aangc(S)No.Lot. Bk)cii. Subdivision <br />19. TYPE OF PROJECT (Ch€CK ONE) <br />P’^OfCCt Mtiii attect^l^aM Qwettand or □ Wac«fCour$* <br />ry\ .v... ^ <br />□ excavate <br />□ fill <br />□ dram <br />□ construct <br />□ mstaH <br />□ repair <br />□ remove <br />a abandon <br />lCother (specify) <br />□ Shoreline □ shore-protection <br />□ channei □ harbor <br />□ sand blanket ^permanent dock <br />□ riprap □ «vharf <br />□ obstruction <br />□ bridge <br />□ cutvm <br />□ dam <br />□ other <br />ispecM <br />ESraMIB RMJKT CMT $H LENGTH OF SHORELINE AFFECTED (IN FEET)XO <br />W. <br />m. <br />VOLUME OF MATERIAL FILLED OR EXCAVATED (IN CUBIC YARDS) <br />BRIEF EXPLANATION OF PROJECT: (EXPLAIN WHAT PROJECT CCM^ISTS OF AMO HQW WORK WILL BE DONE) <br />'+■ -R-.-'v 3a.' ■Jm MP' <br />rKU>c4».^K'» u.u» *i*Ll H ^ <br />PURPOSE OF PROJECT: (Explam why th« proiect is neede^ <br />"TV*- OwolL urwkf X <br />t-rwr r-ift h <br />BNMOMKNTIL MMCT (Anticipated changes to the water and related land resources, including unavoidable but detrimental effects) <br />BlfMTIwn (Other alternatives to the action proposed) <br />Sevt »Vwc /{)e%£jC iV g,lAfe.u^V\^^c. <br />I h*mby m*ka appSeiiior pursuant B Minn**oii SiaiJtM Chaper 103G.245 and M »ppor*i9 fult* tor I pwmit X) vwk « Of ilhct hi ib«e MmedprehCBd <br />Miw(s) in accordwtcawsi al supponin) mapt, plans, a-sd Mhtr nbrniaion submilM«f) M appSeaixv Tlw Mormafon tubmiOidand staWiMMaiMM <br />oonearnins tiB applcatnn ara true and conact to n« bast of myjunWadga. <br />STATE Of <br />COUNTY Of <br />Labsaibad and <br />Distribution; <br />White: ONR <br />Blue: SW(» . <br />Green: Watershed District <br />Cjoldenrod: City or County <br />Pink: Army Corps of Engineers <br />Carwy: Applicant