Laserfiche WebLink
Rev. 12/81 PERMIT APPLICATION TO WORK IN PROTECTED WATERS OR 1NETUNDSt. NA.U«At .UOURCeS UFtlY)Please read instructions before attempting to complete this application.PART ADEPARTMENT OF OFFICE USE ONLY R.A. Nb.□swco ac/c □w.0.i □«Applicant’s Name (Last, First. M.l.) <br />ULRICH. VllllAm ____ <br />Authorized Agent (if applicable)John Uoble 612-541-03A4 x560 Telephone Numbers area code <br />( 612) 471-0795 <br />Address (Street. RFD, Box Number, City. State. Zip Code) <br />Bohno Point Road. Wayxattt. MN 55391 <br />Government Lot(s)Quarter Section(s)Sections(s)Township(s) <br />Fire No., Box No. or Project Address <br />1555 Bohna Point Road. Vayzata <br />County <br />Uennepin <br />Range(s)Lot. Block. Sub-Division <br />Project will affect Lake. Wetland or Watercourse <br />lAkp mniiAtenlui ^ <br />II. PROPOSED PROJECrr <br />□ fill <br />□ drain <br />□ remove <br />□ abandon <br />□ install <br />□ excavate <br />jgygonstruct <br />□ other (specify) <br />IV. ESTIMATED PROJECT COST <br />ono-i <br />ill. PROJECT AREA <br />□ dam <br />□ lake <br />□ wharf <br />□ bridge <br />□ harbor <br />□ riprap <br />□ channel <br />□ culvert ; <br />□ wetland <br />Qtshoreline <br />□ obstruction <br />□ watercourse <br />□ sand blanket <br />□ permanent dock <br />□ shore-|ito^t.S£. <br />□ other (specit^y ^i] W ^ ■■ 1 <br />^ \ \ . 1 . ‘ <br />REGION VI <br />WATERS <br />tr.* <br />m •• <br />BRIEF EXPIANATION OF PROJECT <br />Inatall 4" ductal iron pipe ground water heating discharge pipe for a distance of <br />approxlaiaCely 100'. (aas attached site plan) (Ree atcachad^perWit 8o-6178 for wsM? Ap <br />Kalntenance dredging to renore silt and x&ock to clialnata dailgeroue sltoatlxm to he <br />ed br filter blanket.nnd nre-washed sand axon * —n *W|cco»::d <br />iV' i' <br />project IS neSaeoTnotedJ08IIHCAIIUir(Exprain wny this project is neeaearnoted on drawing by Coffin 6 Gronberg. <br />•jly provide ' yitci—i’ound uicclAaxgc poiiit for cutluc for ^roui.d vatcr coupled h^-AAt <br />puep ilow. . . <br />[TAL IMPACT (Anticipated changes to the water and related land resources, including unavoidable but detrimental effects) <br />So iQttg—ter® envlronasntal change to lake bottoa or water quality characteristics <br />after ccmstruccion. <br />ALTERNATIVES (Other alternatives to the action proposed) <br />Discharge on surface* Thls^wlll cause a build up of Ice and/or the possibility <br />of open water In winter* <br />IX.I heeby fnaXt application pursuant to Minnesota Statutes Chapter 105.42 and all siipponing rules lor a permit to work in or affect the above rranwd proter^ <br />wateits) In accocd2ifvr>e with all supporting maps, plans, and other information submitted with this application. The Information submitted arwi statements made <br />STATE OF ""2^^ <br />couyVy ' <br />and sworn to b^e m| thi <br />of <br />Signore nf Date <br />Siinature of Leasee Date' <br />Distlibution: <br />White: ONR <br />Blue: SWCD <br />Green: Watershed District <br />Goldenrod : City or County <br />Pink: Army Corps of Engineers | <br />Canary: Applicant <br />____j jk