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<br /> Project Name and/or Number: SER#2014-026-03—1165 Ferndale Road N,Orono
<br /> PART ONE: Applicant Information
<br /> If applicant is an entity(company,government entity, partnership, etc.),an authorized contact person must be identified. If the
<br /> applicant is using an agent(consultant, lawyer, or other third party)and has authorized them to act on their behalf,the agent's
<br /> contact information must also be provided.
<br /> Applicant/Landowner Name: Robert Brook
<br /> MailingAddress: 1165 Ferndale Road, Orono, MN 55391
<br /> Phone: 612.328.2562
<br /> E-mail Address: rbrook@emsinet.com
<br /> Authorized Contact(do not complete if same as above): Frank Svoboda—Svoboda Ecological Resources
<br /> Mailing Address: 22752 Co Rd 7, Hutchinson, MN 55350
<br /> Phone: 612-384-7770
<br /> E-mail Address: franks@gpsinnovatitons.com
<br /> PART TWO: Site Location Information
<br /> County: Hennepin City/Township: Orono
<br /> Parcel ID and/or Address: 1165 Ferndale Road N (PID#02-1 17-23-43-0026)
<br /> Legal Description(Section,Township, Range): Lots 2 and 8, of North Shore Cottage Acres Lake Minnetonka
<br /> Addition, a portion Section 2, Tl 17N, R23W, City of Orono,
<br /> Hennepin County, Minnesota
<br /> Lat/Long(decimal degrees): Lat.44.968684(44°58'7.2624"N)/Long.-93.550656(93°33'2.3616"W)
<br /> Attach a map show�ng the location�f thP�irP in relation to local streets, roads, highways.
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<br /> Approximate size of site(acres)or if a linear project, length (feet): .8 Acres
<br /> If you know that your proposal will require an individual Permit from the U.S.Army Corps of Engineers,you must provide the
<br /> names and addresses of all property owners adjacent to the project site. This information may be provided by attaching a list to
<br /> your application or by using block 25 of the Application for Department of the Army permit which can be obtained at:
<br /> http•//www mvp usace armv mil/Portals/57/docs/resulatory/RegulatorvDocs/ensform 4345 2012oct.pdf
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