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r <br />IS <br />I <br />�.� <br />AN <br />NA - 02b22 03 / ( ' / <br />Ro, I,, -i,, PERMIT APPLICATION <br />DEPARTMENT OF TO WORK IN PROTECTED WATERS 04 WETLANDS <br />(r4litil q, 1I4CIUMN DAM SAFFTYI <br />NATURAL RESOURCES <br />► ► Please read mstructinns before attempting to complete this application <br />OFFICE USE ONLY <br />P <br />C7swco 0CrC <br />(� w U 0 USCOE <br />Applicant a (Last. First. M I) Authorized cj applicable) <br />Telephone Numbers,,••,,-,.t <br />MAICQ, MILLI M J. .10= NMI 1(612 <br />) 671-0795 <br />Address IStreet, R D. Box Number City State Zip ode) <br />LOCATION OF PROPOSED PROJECT (13E_ SURE TO INCLUDE SKETCH SHOWING HOW TOGET TO THE SITE) <br />Government Lot(s) <br />Quarter Section(s) <br />Sectlon(s) No <br />ownship(s) No <br />Range(s)No <br />Lot. Block, Subdivision <br />81i 1/4 <br />i <br />117 <br />23 <br />Fire No Box No or Project Address <br />_ <br />County <br />Proje(r wilt.dtect Lake Wetianr7or Waterrour. <br />S35 Bohn a a Point RO&A.Waysets <br />6T, <br />Hannejpin <br />name8 number <br />fk n Lb Minnetouka <br />PE OF WORK PROPOSED (CHECK ONE) <br />ID. TYPE OF PROJECT ((_;HECK ONE) <br />❑ excavate p repair <br />A shoreline ❑ shore -protection D obstruction dam <br />❑ fill ❑ remcve <br />(; channel ❑ harbor ❑ bridge I .; other <br />O drain ❑abandon <br />sand blanket ❑ permanent dock 11 culvert (specify) <br />Qconstruct ❑ other (specify) <br />Ckinstall <br />riprap ❑ wharf <br />E=TIAATED PUJECT OUT $ 5.000.00 <br />h. LENGTH OF SHORELINE AFFECTED (IN F E f T ) <br />VOLUME OF MATERIAL FILLED OR EXCC.VATED (IN CUBIC YARDS) <br />BRIEF EXPLANATION OF PROJECT 0 -PLAIN WHAT FHi i rl (T CONSISTS OF ANDHOW WORK WILL BE DONE <br />Install 6" 1. dectdl frowiA water beating 1laabarge PIIN• <br />PURPOSE OF PROJECT (E xplaln wf� t+ils project is needed! <br />To provide safe, year --round diRch,arge Point for outlet :or grorand V@tst eompled heat <br />Ij� flow. <br />E NTAI NOW (Anticipated changes to the water and related land resources, including unavoidable but detrimental effects) <br />•s I*" —term enwirea�tal change to Inks bottom or Prater quality characteristics <br />AITRUTIM (Other alternatives to the xtion proposed) <br />ftacharae on surface. This will cruse a build up of its ants/sr Um possibility <br />unatasla •d�� <br />licant s Nam A Pnt (if a Itcable <br />Distribution <br />twebv make application pU SAW1 to hhrutesola Statutes Chapter 105 42 and all supporting runts for a permq to work ,n o' affect Me above named aorerted <br />waterisl ,n accordance with all supporting maps plans and other mfOrmatton submitted with this apW,cahon The information gut m"W and slate"wis made <br />Concerning NHS apphcafton are hue and (area to the best of ny knowledge <br />�tATF OF <br />L,OUNTV OF <br />'"W.rrbed and sworn to bekrre ma NHS <br />day of _ a <br />M4 cor"Mf" n tapHaa <br />S,gnaare a, Notary <br />White DtWi <br />Blue SWCO <br />Cir self W a'tsrshed Drstr to <br />rlrirrrr:yj City of cOUfTty <br />PrnU Army Caps of E f141►lee/ s <br />Canary Applicant <br />