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� I '.� ,,.n�u ut LOCAL_STATE - FEDERAL WATER RESOURCE PROJECT NOTIFICATION / APPLICATION FORM
<br /> i��,�� �hi;, furm tu notify/:�pErly t�, thr, U.S. l�,rmy Corp�, of Enqineers, the Minnesota Department of Natural Resources, �nd your Local GovFrnment Unrt
<br /> <�f �� ��r���,�,sed w;�t�:rl�v�:tl�in,i pr��;ect ��r wurk which may fall wrthin their junsdiction. These agencies should adwse you of their�unsdietiori or permit
<br /> r�:yuircrn��nrs v�ithin 45 days. Some LGU's may also require submission of their own application forms. Fill out this form completely and mail a copy,
<br /> vvith ��I,�n�,, ni�,��a, r,tc. t�, F;;ir.h of the ayencin�listr,d on ihe reverse of the form. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED
<br /> AUTHOR�7ATIONS BFFOR[ BEG!PdNING WORK. �
<br /> AGFPJCY U�E Of1�Y_ LGU NUMBER: MDNR NUMBER: CORPS NUI�BER:
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<br /> A���,I�c.�nt's N�unn !�;ist, First, M.f.l AuthoriZed Agen[, if anV Area Code, TelephOne
<br /> -��7z r2 Pr� � r-r-�� L� ��/ �/�� - 1 Z v"�
<br /> q�l�.li�:�,�., i'��r;�,�.t �I:r) Bnx �Junit��;r, Cily� S(d(e, Zip Codel
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<br /> !li_ �_�,, ,� ,,� � f .r�,�,�.:.�n1 ��ru�cct iu rh dr j vin�� sno�wmy ho�,�v to get to site) - /� /
<br /> _-- - �t' � S C.�/�-l�e� y'%I -�tE'
<br /> r'U�ii�7�� QUAF'ER SECTIGN(s1 �ECTIONS(:;1 Pdo. TOW�SSHIP(sl No. RAPdGE(sl No. Lot,� leck, Subdivisior
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<br /> Fli-,� fJ��., �OX N��., Of. PROJFCT AODRESS NAME OF WATERBODY AFFECT[D �nd NUMBEP, (IF KNOWN! /' J )�.
<br /> < A�h t� /l.S � i's�•L �„1.��: 1�1 e nv�C.- ���e 6 r 1. �t�'r'Yt- Z � -j �J fi7' Z
<br /> III. ESTIMl1TFD PROJECT COST: S �] ��� _ LENGTH OF SHORE AFF[CTED (in feet): �
<br /> 1 4�.i`_
<br /> IV. VCLUME OF Fll_L OR EXCAVATION (Cuk�ic Ya�ds): (iVt7TE: Vou mnysuba�tituto rlimensionsi
<br /> AREA FILLED OR EXCAVATED IS � Acres, OR Squ,3re Fce[
<br /> J T��F'E UF 1NOfiK AND AREA ICHECK ALL THAT APPLYI: I�; AccFss PnTw I_l BHiDcr [1 Cu�vEFe� ❑ Dnn�
<br /> ��'�ONSTRUCT U DRAIN U EXCA�'ATE [�DocK ❑ Rir�RAP I S�,Nou�nnr�KET
<br /> ', F iLL [7 REMUVE ❑ REPAIR
<br /> ❑ LAKE f J SHORELINE LJ VVATERWAY (_7 WETLAND
<br /> OTfiER ([')cSCRBEi:
<br /> WETLAfJD TYPEISI AND ACREAGE151 PROPOSED TO BE FILLED/DRAINED:
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<br /> Atrn;h �ipplic�ik�lr; drawinys, plans, and ASCS crop photos. Include a descnption of any proposed compensatory miUgation. Importan[: �IdenOfy
<br /> �,n d�r�se♦i and borrow areas. Descnbe the work below� how it would be done; what equipment would bP used.
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<br /> �.- �..,�=:,r a� � `4 0-- 4 � 2 6 � �� �. �-- C�; �w a ,.
<br /> VI PRnJECT PURPOSE {Wny is�this projecr needed-what bonefits will it provide�l: ��V�,��� A i� C�
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<br /> VI! AL i ERNA I IVEj (de,���nbe any other sites or methods that could be used to achieve the purpose of your project whilo avc,idin�� or minimmn�
<br /> ;��r;ts„rnl�v�.itcr ��u��ects. Attach addiuonal sheets, if nuededl.
<br /> t�A
<br /> Vlli U/����ES: Pro�,os�;d eturt of activity: �� -�j `� Proposed completion: �- 15�� �J�
<br /> (IrI��nUfy any complF;tod work on an attar_hed drawiny)
<br /> Ik al)JC'�I^JWG PROPERTY" OWNERS IAttach lisi if more than twol
<br /> � Nrime Address _ City S�ate Zip
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<br /> X- F'En��iITS h�ive been received lenter an R) or already applied for 1�rter an A) from: DNR ARMY CoRPs ciF ENGItiEERS CoUNTY
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<br /> TO\'dN!CIlY _WATERSHED DISTRICT _ MPJ PO�.UITION CONTROL AGENCY
<br /> H �>: an ,irr.haeological survey of the pro�ect site been done7 If so, by whom:
<br /> 1 hereb� notify the recipients of this form of the project proposed herein and request that I be advised of any permits or other determinalions conceming
<br /> this project that I must obtain. I understand that proceeding with work betore all required authorizations are obtained may subject me to Federal, State,
<br /> and:or local admi ' trative, civil and/o c iminal penalties.
<br /> �"� ��� ,?
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<br /> �--�_ c �""� DATE: .7 J�-
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<br /> Siynature of Person Prupos ng Proje�t or A�ent ���
<br /> <<< PLEASE CAREFULLY READ AND COMPLETE BACK OF FORM>>>
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