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�r' AI�PLTCATIO�i rOR'D�PARTMENT OI'THE AR]VIY P�RiY1IT(33 CrR 325) O�u�APPROVAL No.0710-003 Expires Dec 3I,2ooa.
<br /> �� The pubGc burden for this collection oF informadan is cstimated�o average l0 hours per response,although the majority of appGcations sliould require 5 hours or less. This includes
<br /> the Ume for reviewing Inswc4ons,searclrin�exisung data sources,guthering and m�inlaining Uu data needed,and completiag and rviewing the collecuon oF inFormadon. Send
<br /> comments regarding this burden estima�e or any other nspect of�us collecdon of infarmadan,including suggestions For reducing Uus burden,to Department aC�eFensn,Washington
<br /> Headqunrters Service D'vectorate of InFonnation Opemdons and Reports,1215 JeFferson Davis Highwuy,Suitc 1204,Arlington,VA 22202-4302;and to the ORce oF Management
<br /> and Budget,Paperwork Reduction Project(0710-0003),Washington,DC 20503. Respondems sl�ould be awnre U�nt notwithstancling any other provision of Inw,no person shall be
<br /> subject to nny penally for(aiGng to comply with a collectlon of informatioo if it dces nol displuy a currently vuGd OMD control num6er. Pleuse DO NOT RETURN your fortn to
<br /> either of Utese uddresses. Completed applicadons must be submilted to U�e Dlstrict engincer having jurisdiction aver the location oFUic proposed nctivily.
<br /> PRIVACY ACC STAT�bIENT:Auuiariues:Rivers and Hurbors Act,Section 10,33 USC 403;Clean Water Act,Sec�lon 404,33 USC 1344;Mnrine ProtecUon,Research ond
<br /> Sanctuuries Ac1,33 USC 1413,Section 103. Princip•rl purposc:lnformation provided on this fortn will be used in evoluating�he opplicatioa[or a permit. RouUne uses:This
<br /> infomc�tion may be shared wilh the Departmenl of Justice nnd olher Federal,stule,nnd local goverrurlenl agencies. Submission of requested inforrtwlian is voluntury;however,if
<br /> inform�don is i�at oravidcd,the perntit applicnlion cannot bc cvalualed nor can a�ermit 6e issued.
<br /> ITENIS 1 THROUGH 4 TO BE FILLED IN BY THE CORPS
<br /> I.APPLICATION N0. 2.F�LD OFF[CE CODE 3.DATE RECENED 4.DATE APPLICATION COMPLBTED
<br /> YOU DO NOT NEED TO COMPLETE ITEMS 6-10 and 12-25 tn the SHADED AREAS. '
<br /> rill applicants must complete non-shaded items 5 and 26. If an agent is used,also complete items 8 and 11. This optional Federal form is valid
<br /> for use orely when included as urt oF ttus entire state a lication acket,
<br /> 5.APPLICANT'S NAME 8.AUTf�I0R1ZED AGENT'S NAME AND T1TLE(an agent is not required)
<br /> Ryan Companies US,Inc. Mark S.Miller,Project Manager
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<br /> I1.STATEI4I�NT OI�AUTIIOR.F.ZATION(if applicable;complete oniy jf'ar�tharizing an agent)
<br /> I hereby nuthorize Mark S.Miller to act on my behalf as my agent in thc processing of this application and to fumish,upon
<br /> request,supplemcntal information in support th' pe t np ' ion.
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<br /> APPLICrWT'S SIGNATURE: � � L�.++ Csw/r G/S�.,Ly�?ATE: L L d J
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<br /> 2G. Application is hereby made for a permit or permits to authorize the work described in this application. I certiCy that the information in this
<br /> application is comple e and accurate. I furttter certify that I possess the authority to undertake the work described erein or atn acting as the du(y
<br /> uuthori gent o e applicant. /
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<br /> .�i������ ,R���-.w.fys �5 �'�. /z/��a�
<br /> Signature p 'c•nt ate �gnature of geut(if any) � Dute
<br /> The applic i n must be signed by the person who desires to undertnke the proposed uctivity(applicunt),or it muy Ue signed by a duly uuthorized agent if
<br /> the stute • in Block 11 has been filled out and signed. 18 U.S.C.Section 1001 provides tl�at:Whcevec,in any mnnner within the jurisdiction of any
<br /> depnrtment or agency oF the United States kno�vingly und willFully falsifies,conceals,or covers up witli any trick,scheme,or disguises a material Fact or
<br /> makes any false,fctitious or fraudulent statements or represenlations or makes or uses any false writing or document knowing same to contnin unyfalse,
<br /> fictitious or fraudulent statcments or entry,shall be fined not more than$10,�00 or imprisoned not more than five years or both.
<br /> ENG FORM 4345,Jul 97 EDITION OF FEB 94 IS OBSOLETE. (Proponent:CECW-OR)
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<br /> iviinnesota LocaUState/Federal Application Forms for Water/Wetland Projec[s ��� " "' i:;�
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