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Nl <br />R. <br />rr^department of <br />NATURAL RESOURCES <br />PEBMfT APPLICATION <br />TO WORK IN PROTECTED WATERS OR WETLANDS <br />IWClUDtNE DAM SAFTTYI <br />PART A <br />► ► Please read instructions before attempting to complete this application <br />OFFICE USE ONLY <br />OA NO <br />W{) <br />SWCD DC/C <br />Dw.D. DUSCOE <br />1.Applicant s fJ^me (Last.^st. M.l. <br />'i/f /as E- <br />IH3TT <br />\f <br />Authorizea Agent (il apoiicaDie)Telephone Numoer&areaccxx <br />^ /A) <br />Address. <br />Governme _ ___ <br />Zip Cooe) <br />P/ocTS M SSJ9/ <br />ictionsis)' <br />^ <iG( <br />Fire No., Box No. or Project Address <br />Township(s)Range(s) <br />Counwil M A <br />tm <br />P a>i <br />‘watercourse <br />Lot. Block. <br />Project will affect Lake. Wetland or <br />7!:5,tSV"’“'7 >♦ JsL <br />fOr <br />II. PROPOSED PROJECT 111. PROJECT ATIEA <br />□ fill XI excavate □ dam □ culvert <br />□ drain □ construct □ lake □ wetland <br />□ remove □ other (specify)□ wharf □ shoreline <br />□ abandon □ bridge □ obstruction <br />□ install □ harbor □ watercourse <br />IV. ESTIMATED PROJECT COST □ riprap □ sand blanket <br />^ !).6d A □ channel □ permanent dock. <br />□ shore-protection <br />□ other (specify) <br />• D.YC4* <br />#fxS <br />Am<Vi, <br />1 ■ ^ M1"- ij <br />V. <br />\n. <br />BRIEF EXPUHATIOK OF PROJECT , jO 4^ ^ ^ -hi <br />X u»oo\J JOU. MK ^rcA /A <br />•Q>r 46l aCJw. e^‘f~_________’7S‘* ^ A <br />JU^FICAT10lK(Exprairi why this project is needed) <br />j .i ^ ^ i ^ <br />J^. <br />VII. <br />T t L xvU M/..J .-K — <br />w4;l w rvjsd h UjLir^.y»i I <br />iA/^r M. 1m Vi'lLcf TAiS. jOy CA So A Acf/jf-^ <br />^mlllDNMENTAL IMPR^ (Anticipated changes to the water and related lane resources, including unavoidable but detrimental effects) > <br />f-- Uitc/ yj}/^ve4c; i> \ / * *K- <br />■Hv\A. i(-y- L^iJlM WJ-C7 TVgryu. 7vJL^ A^>UL urcc'^» <br />ALTERNATIVES (Other alternatives to the action proposed) <br />nay^s'fK*- vx ^okU lEsisLm-(. <br />)lej/p /h\ les^j-__________________________ <br />IV maKeoDDlication putsuant to Minnesota Statutes Chaoier 105.42 ana all supDonmg rules tor a pennit to wont in or al <br />vni. <br />IX.I hereby maKewplication put^nt toMinn'esota Statutes Chaoier 105.42 and all supDonmg rules tor a permit to worn in or atieci tne aoove nameo proteaed <br />water(s) in accordance with at' supporting maos, plans, and other .information suommed with this application. The information suommed and statements made <br />STATE OF <br />COUNTY OF <br />MUUi <br />Subscribed and sworn to before me tni^ <br />day ol ______19 <br />Signaiur/ot Owner or Arntterizeo ^egK^;r f r CP / <br />Sigk^ture^Cfcrfsee Date <br />My commission expires <br />Distribution: <br />^AAAAAAVyAAAVUWSMAAAMAAAMAAAAAMV White: DNR <br />10.TIA.THEN I Blue: SWCD <br />SDHRyPUBUC*MINNESOTA \ Green: Watershed District <br />HENNEPIN COUNTY I GoldenrocJ: City or County <br />IJyCHnmlsdoD Ellies Apr. 15, 1988 | Pink: Army Corps of Engineers <br />*vvwwvvvvvvwwvvvvvvvv\~'A^ Canary; Applicant