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� � Project f�a^-e ardlor Numb=r 701 Dick_� Lake Drive <br /> PART FOUR: Aquatic Resource Impactl Summary <br /> If your proposecl proiect invclves a direct or indirect ir��p�ct to an aquatic resource Iwetl�nd, lake. tr�butary, etc j identify e�ch <br /> impact in the tab;e below. Inc:ude all ar,ticipatec impacts, mcluding those expected to bF temporary Attach an OVPfF1P�C VIPVJ <br /> map, a�rial photo, andJor drawir.K showinK al; of the aquol�c re�ources in ;he project area and the location(5) �f the pro(�oscd <br /> impacts. Label e�ch aquutic resource on the map with a reterer.ce number or ,etter and identit��the impacts in the followin�tabie <br /> I; 4uatic Resource' A uatic � . _ ______i__ _ _ <br /> ' Type of Impact� Duration of I County, Major <br /> q � Existing Plant <br /> A {fill; excavate, j Impact : Qverall Sixe of Watershed k, ' <br /> Resource Type ' Community <br /> ' ID;as noted nn cirain,or I Perman�nt ;Pj 5ize of Impact'', Aquatic � and Bank <br /> i::�etland, lake, 3 ' TYPe(5) in <br /> i overhead view) ' remove or TemNotary Resource � 4 Service Area tl' <br /> tributa►y etc.) , Impact Hrca �: <br /> vegetatian) (T) o+Impact Arca"' <br /> . i ._.. . ---�------_----� --_.�--- <br /> �I <br /> �. ..—_.__—..._... . . ._. ...._. .. . . _ � . . <br /> i <br /> 'Ir impacts are tc�ii�orary�,ent^r-ne d�.rati�n of,Fe impacts in da+;s next,c th�"T" F^r eKample,a ��ro,ect with a tem�orary a�-cess fill that <br /> v.�o.ild be rem�ved�*ter??0 days wr,uld be en?�rPd"T(�20►". <br /> llmpacts less than C�.U1 aere shvuW be repvrted�n syuare feet. nnpdct,U.::1 acre _r g•::atcr sho.,ld be rcported as acres a��d •ounded te tho <br /> nearest 0.01 acre Tributaiy ir�ip�cts must be reperted in Imea�feet of_impact znd zn area of impa��by r�d�cat�ng f�rst thz I near feet of impa:t <br /> along the flotivline ot the stream follov:ed bp•ttiP area i�n:art in parenthesesj. For e�:�mp�e,a p��je�-that impacts 50 feet ct c stream that's E <br /> feet tivide would be reporteC as SG ft(3�0 syuare fee;1. <br /> '?his is gener�l y only ap�licab:e f ti�o�are app'ying for a d?minimis exemption un�er t�N Ri les 8�2�'�a2�Subo. A,otherwise=_rter"N,�A". <br /> 'Use Wetion,d Plontc n�d Plont C.omm;.r�ty Types otiv;�nneso.o ono''.1�isconsirr 3"Ed as modifiec �n MN Rcles 84?O.J405 S;.bp. 2. <br /> �� sRefer tu Maj��Vdat.rshe::an� 13ank 5en�ice Area ma;,;s�n M:N Rules L�41U D522 Subp 7 <br /> If any of the above identified impacts have already occurred, identify:vhic.h �mpacts tnPy are and thc�circ.umstances associa;ed <br /> with each: <br /> PART FIVE: Applicant Signature <br /> ��, C`IIPCI: F1PfP If ycu ;�r�r�q,�e;ting a p*e-application cans..ltaucn�vith t^�e Co�pti and LC�U 'based on the ir:formation you have <br /> provided. Regulatory entitie�will not initiate a for��ral application revie�a�if this box is checked. <br /> liy signalure below, I at?est that the in`ormalion in Lhis application iy c�rnplete and accurale 1 furlher dltest that I pos5e55 lhe <br /> uuthority tv undertake the work described herein. <br /> 1 �� <br /> Signature� �_��'`�- ��" Date: � - l� -1 � <br /> - ----_—�_ <br /> hereby authorize to act on nr;behalf as my agent in thc processing of thu application and to furnish, upon request, <br /> supplemental information in s�ippnrt nf this application. <br /> 1 The term "impact" as used in this joint application form is a Reneric term used for disclosure purposes to identify <br /> activities that may require approval from one or more regulatory agencies. For purposes of this form it is not meant to <br /> indicate�vhether or not those activities may require mitigation/replacement. <br /> ftilinn�sota interagency\ti'ater Resource Applicat�on Farm Fe�ruary 2U1A Pake 4 0(il <br />