Laserfiche WebLink
ProJect Name and/or Number; ��_�� <br /> i <br /> PART FOUR; Aquatic Resource Impact1 Summary � <br /> If your proposed pro)ecT lnvolves a direct or Indirect Impact to an aquatic resource ;wetland, lake, tributary, etc,) Identify each I <br /> impact In the table below, Include a!I anticipated Impacr,s, Including those expected to be temporary, Attach ��n overheac vlew �I <br /> map, aerlal photo, and/or drawing showing all of the aquatic resources In the pro)ect area and the lo:a:lon(s) cf the pro;�osed ( <br /> Impacts, Label each aquatic resource on the map.with a r�ference number or letter and Ldentify the impact� In tha following•;able. <br /> q Aquatic TYpe of Impact Duratlon of Exlsting Pf�nt County, MaJor <br /> A uatic Resource fill, excavate, <br /> ResourceType .�� Impact Overall5lze of WatersF�ed #, <br /> ID(as noted on draln, or Permanent(P) Sfze of Impact' Aquatic Community and B:�nk <br /> overhead vlew �wetland, lake, <br /> � remove, or Ternporary Resource ' Type(s) In � 5ervlce E;rea� <br /> tributary etc,) Imp�c:Area S <br /> vegetatlonj (T)' of Impact Area <br /> 11f Impacts are temporary;enter the duration of the Impacts Ir days next to the"T", For example, a proJect�Nlth a temK�or.ary�3ccess flll tha: <br /> would be removed after 220 days wou{d be entered "T(220)", <br /> tlmpacts less than 0,01 acre should be reported in square feet. Impacts 0,01 acre or greater should be reported as acres and rounded to the <br /> nearest 0,01 acre, Tributary impacts must be reported In Ilnear feet of tmpact and an area of irnpact by Indlcating first the Ilnear feet of Im{�act <br /> along the flowline o(the stream followed by the area Impact In parentheses), For example,a proJect that Impacts 50 feet of a stream that Is 6 <br /> feet wlde would be reported as 50 ft(300 square feet), <br /> 3Thls Is generally only applicable If you are applying for a de minimis exemptlon under MN Rules 8420.0420 Subp,8,otherwise enter"N/A" <br /> °Use Wetland Piants and Plvnt Community Types oJMlnnesotp and W'Isconsln 3`d Ed,as modlfled In MN Rules 8420,0405 Subp 2. <br /> SRefer to MaJor Watershed and eank Servlce Area maps in MN Rules 8420.0522 Subp.7, <br /> If any of the above Identifled Impacts have already occurred, identify which impacts they are and the clrcurristanc�s assoclated <br /> with each; <br /> PART FiVE; Applicant Signature <br /> ❑ Check here If you are requesting a pre-applicatlon consultatlon wlth the Corps and LGU based on the in1'ormaticn y�ou have <br /> provided, Regulatory entlties wlll not initlate a formal applicatlon revlew if this box Is checked, <br /> By slgnature below, I attest that the Informatlon in thls ap�llcatlon Is complete and accurate, I further attest that I possess the <br /> authorlty to�mdertake the work described hereln, <br /> ignature: � <br /> Date; <br /> � hereby authorize__ w -.�— � .Sn� to act on my behalf as my agent In the proc:essing of this appllc�tlon <br /> . and t urnish, upon request, supplemental Informatlon In suppert of thls appl!catlon <br />'The term"Impact"as used In thls Jolnt appllcatlon form Is a generic term used for d!sclosure purposes to identlfy <br /> activitles that may requlre approval from one or more regulatory agencles. For purposes of this form It Is not meant to <br /> indlcate whether or notthose activitles may requlre mltigatlon/replacement, <br /> Minnesota Interagency Water Resource Appllcat(on Forr-�1=ebruary 2014 <br /> Page 5 of 13 <br />