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- AD�3�IV9����1 - <br /> Notice to A�plicants for DNR Permi4 to Char�ge Th� �Co�rs�, <br /> Curr�nt or Cros�-Section of Protected Waters <br /> The Department�f Natural Res�urces(DNR)and the Pollutlon Conhol Agency(F'CA}are working logother,fio avoid dupllca- <br /> tion In stote ogency permit reviaw of�xoposed activlties attecting protected waters in fUlnnesota.The cattc�cheti torm wos <br /> prepared by the DNR and the PCA to minimize your work in contacting staTe agencles for proJect approval;�� <br /> �lecse com;�lete this form by placlnfl an'X'In the apprapriate box or boxes.If your pro;ec'doos not InvoNe any ot the <br /> actions lisiad r�n thls farm,placo an`X'in?fie box aftor Item 9. <br /> If your�roJect w�ll Involve any of the acilons Ilstod for boxes 1 through 8,a copy of yo��r DNR permit application will be <br /> forwarded ta thc��CA for thelr review.ff a separate PCA permit or capproval is requlred,you wlll be so notlfied t�y th�PCA. <br /> Place an'X'In the a�proprlate box(c�s): <br /> ❑ 1, Tho praject will involve the deposttion of asphalt,concrete,c�t vegetation ar oth�or solid waste as�ill � ateriai. <br /> ❑ 2. The proJect wlll Involve oxcavcrtlon of matQrials from protected waters through the use of ar,y do�wr.ich removes <br /> maPerials�y pumping or suc7on actlon(le.h�/drauLc dredgtng). <br /> ❑ 3. The proJoct will invalve excavation of rnore than 1,000 c�bic yards of materfal from the beds of tt;e followin��waters: <br /> ❑ Lake Pepin of the Mississippi River(River Miles 763 to 787 USCE charts). <br /> ❑ Pool�21n th6 Mississip�l River from Lock&Dam#�l (the Ford Dam)to Locic&Dam�2(Hastings-R(ver Miles 725 to 814 <br /> USCE charts). <br /> [' P,�innesota River irom Savoga to Its mouTh at the Mlsslsslppl�2Ner(Mile 844 USCE Rfver ct�art.) <br /> ❑ Duluth$uper(or Hc�rbor and ihe St.Lo�is Bfly area of the St.Louis RNer extending to Spirtt Lake. <br /> [] 'fhe Falrmo�t chain of lakes Including 6udd.Siseton,Nall and Ambc�r Lakes in Martin Cour�ty. <br /> ❑ Alber*Lea Lake.Freeb�rn Counfy. <br /> ❑ Warroad River Upper Harbor Area extending iromi The mouth of tho Warroad River to CSAH Na 11. <br /> ❑ Red RNer of the North from Wahpeton to ihe Canadlan bordQr. <br /> ❑ Q. Tho proJect wlll Involve excwatlon and/or flll in protected waters for construction of utlllty Iines carryinfl any materiais <br /> except troated water in a Ilquid or seml-soild state,including but nat Umited to peYrolaum or petroleum proclucts, <br /> chemicals,sewage cx coal slurrles. <br /> ❑ 5. The proJoct wll!Invoivo construction of docks,piers or wharves which wlll Involve new fuel handling facilitios. <br /> ❑ 6. The proJect will invoive new constructicn,reconstructicn or repair of struct�res for generatlon of hydroelochlc power. <br /> ❑ 7. The proJecT wlil involve constructlon of new anclllary facliftles fcx santtary sewers,boaf pumpo�.�ts,on-site waste <br /> treatment or holding tanks. <br /> [l. 8. Tho project will involvo the on-site disposal by burning of vegetotion to be romoved during proJect construction. <br /> � 9. The pro;ect will not Involve any of ihe above. <br /> �Applicant Nome(typa or print) Applicant natur ° , 7 <br /> . � ' <br /> � h <br /> � �� <br /> � ''��1���--- '�'� � �.' �} �. �� L�� - �� -G�----- <br /> Applicant Address <br /> ..___ ; <br /> -5�`� � c/��r�� ��,�-��v� c����/�; � �s�-���� ____ <br /> _J <br /> ; ��� For addiGonal informa6on and assistanc�, <br /> .' ��,, contact tho appropriate R�gional Office or the <br /> �__- •� �. <br /> Divisbn of Waters in St.Paul. <br /> -�-,�i �-� ��. <br /> � I �'t ��•�� � ,� Reglon 1 2115 Bir�hmont E3oach Road N.E. Reglon 4 BoK?56,Hghway t 5 South <br /> I ' i ' '" � Bemid�i,MN 56601 New Uim,MN 56073 <br /> � �, r� �� 1 � ,— (218)755-3973 (507)359-6053 <br /> � I � I � Reg�on 2 1201 Eas;:;�ghway 2 Reglon 5 2300 Sliver Creek Rd.N.E. <br /> ; �i , <br /> i <br /> - �I �-I I j I I (a218)327-441 oMN 55744 (5p7)2&5-7430 55906 <br /> � _— <br /> i <br /> i <br /> � � + ' Reglon 3 1601 Mlnnesota prive Reglon 6 1200 Warner Road <br /> '� � ��t i I Brainerd,MN 564C1 St.Paui,MN 55106 <br /> 1 I___� I ;^,` ' i � (2/8)828-2605 (612)772•7910 <br /> z_ <br /> 1 ';_ 'i --- S � � l CeMrel 500 Lafayette Road <br /> � � �� aA F�rinted on Recycled Pape�r onioe St.Paul,MN 55155-4032 <br /> '- � `, (612)296-4800 <br /> �f ' � � � Contains 10%postcorLsumerwaste <br /> �, . i ; � i`� _ <br /> -�- , i�' J This informotior, is available in an afternotive format upon request, <br /> � 4� ` _ '� _ � <br /> � `� j , � � O 1994 State ot Minnesota,Departmsnt of t�atural Resources <br /> � � �5 � <br /> , � : � � <br /> 'L_1 i__ 1 ,.._ . _ 1 _!---�__'l 4 <br /> 1 <br />