MN Wetland Conserv. Act - Notice of Application & Decision

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� IProject Name and/or Number: 1050 Edgewood Hills Road � PART ONE: Applicant Information If applicant is an entity(company,government entity,partnership,etc.),an authorized contact person must be identified. If the II applicant is using an agent(consultant, lawyer,or other third party)and has authorized them to act on their behalf,the agent's contact information must also be provided. � 'I Applicant/Landowner Name: lames Robin � Mailing Address: 22732 Olgilvie Avenue Scandia, Minnesota 55073 Phone: 612-309-3946 IE-mail Address: jamesrandrobin@comcast.net Authorized Contact(do not complete if same as above): Mailing Addresr. iPhone: I 'I E-mail Address: �, i Agent Name: Andrew Krinke I Mailing Address: 26105 Wild Rose lane Shorewood, MN 55331 I Phone: (952)-401-8757 E-mail Address: Andrew@kjolhaugenv.com I! ' n Inf rmation PART TWO: Site Locatio o , ! County: Hennepin City/Township: Orono �I I Parcel ID and/or Address: 0211723130003 I Legal Description(Section,Township,Range�: 52 T117N R23W Lat/Long(decimal degrees): I Attach a map showing the location of the site in relation to local streets,roads,highways. Approximate size of site(acres)or if a linear project,length(feet): 1.51 acres �I i I If you know that your proposal will require an individual Permit from the U.S.Army Corps of Engineers,you must provide the names and addresses of all property owners adjacent to the project site. This information may be provided by attaching a list to your application or by using block 25 of the Application for Department of the Army permit which can be obtained at: http://www.mvp.usace.army.mil/Portals/57/docs/regulatcry/RegulatoryDocs/engform 4345 2012oct.pdf i PART THREE: General Project/Site Information ' If this application is related to a delineation approval,exemption determination,jurisdictional determination,or other Icorrespondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. I IDescribe the project that is being proposed,the project purpose and need,and schedule for implementation and completion.The project description must fully describe the nature and scope of the proposed activity including a description of all project elements that effect aquatic resources(wetland, lake,tributary,etc.)and must also include plans and cross section or profile drawings I showing the location,character,and dimensions of all proposed activities and aquatic resource impacts. Minnesota Interagency Water Resource Application Form February 2014 Page 3 of 11 � -- — —