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ProJect Name and/or Number; �O 1�-^ ,,�,�i$ _ <br /> PART ONE; Applicant Information <br /> If applicant Is an entlty(company,government entity, partnershlp,etc.), an authorized contact person must be IdE�ntlfled� If the <br /> appllcant Is using an agent(consultent, lawyer, or other trlyd party)and has authorized them to act on thelr beha f, the agent's <br /> contact Informat{on must also be provided, <br /> Appllcant/landowner Name; � - - <br /> Maliing Address; p D. B�� ��+� <br /> - ��'s'I <br /> Phone, _ 1012— 5��.} " 34,� <br /> E•mall Address; • . <br /> � , <br /> Authoriz�ed Contact(do not complete if same as above); S� <br /> Malling Address; ' <br /> Phone. <br /> E•mall Address; <br /> Agent Name; � <br /> Mailing Addresa; <br /> Plione; �—'�5�� <br /> 1i�2-R'o�-�GG)s� <br /> E-mall Address; <br /> PART TWO: Site Location Information <br /> County: . C!t Townshi <br /> Yl p� �.ro��,� <br /> Parcel ID and/or Address: �tGb — '�)"j�. }-�};, ` <br /> ���_ �!� - /�.1 ! �%� <br /> legal Description(Sectlon,Townshlp, Range); I <br /> lat/long(declmal degrees): <br /> Attach a map showing the Iocatlon of the sl#e In relatlon to local streets, roads, hlghways, <br /> Approxlmate slze of site(acres) or If a {inear proJect, lengr,h(feet); �, �'.�.. ������, ��_��, , <br /> �•�-_.�. <br /> If you know that your proposal wlll requlre an individual Permlt from the U,S.Army Corps of Engineers, yo.� rnust��nvlde the <br /> names and addresses of all property owners adjacent to the proJect site, Thls Informatlon may be provided by att�:ching a Ilst to <br /> your appiicatlon or by using block 25 of the Applicatlon for Department of the Army permit which can be ab�:alned a:: � <br /> htto�//www mvp usace armv mll/Portals/57/docs/reau'atorv/ReaulatorvDocs/enQform 4345 2012oct n9f <br /> � <br /> i <br /> Minnesota Interagency Water Resource Applicatlon Form f ebruary 2014 <br /> Pa,3Q 3 of 13 <br />