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ProJett Name and/or Number; f�/�.—x.�R' <br /> i <br /> PART FOUR; Aquafitc Resource lmpact1 Summary 1 <br /> ff your proposed proJect Invoives a direct or lndirect fmpact to an aquatic resource ;wetland, lake, tr{bukary, Etc.} Ider,tffy each � <br /> impact In the tab#e below, include afl anticlpated Impatis, Including ihose expetCed to be temporary, Aliach an overheac vlew f� <br /> map, aerfal ph�to, and/or drawing showEng a!i of the aquaiic resources In the proJect area anc4 the lo+:a:lon(sJ cf the pro;�osed ! <br /> Impacts. �abel each aquatfc resource on the ma�wtth a reference num5er or lette�and[dentlfy the impact�ln th�rolfowing•:abie. <br /> i <br /> Aquatic TYPe of tmpact Duratlon af Caunty,MaJar <br /> Aquatic Resource (fill,extavata, !m ac Exlsting Plant <br /> ID{as noted ort Resource Type , � p t Overell Slze of WatersF•ed N, <br /> (�veEland,lake, draln,or Permanen+4P1 Site of�mpact= q��et�� Commun(ty and Bank <br /> overhead vlew) remvve. or Ternporary Resource 3 TYPe(s)In <br /> trlbutary etc.) � Serv{ce Area� <br /> vegetatton; (T)' �mp�c:Ared S <br /> of lmpacr Area <br /> � <br /> lif fmpacts are temporary;enter the duratton of the Impacts Ir:days next to the"T", For examp(e,a project with a temF�orary ac�:ess(IIt tha: <br /> would�e removeo after 22p days woutd be er,?ered"T(22J)". <br /> =i+npacts less then 0,01 acre should be reported in square feet. Impacts 0.01 acre or greater ahoulQ be reported as acres and rouncled to the <br /> nearest 0,01 2cre. Trlbutary impacts mi�st be reported In ilnear leei q(;mpact and an erea of Impact by Indlcating first the Iinear fee;of impact <br /> aiong the fiowllne of the stream fo{lowec!by the area lmpatt{n�arenthesesJ. for example,a proJect that Impacts 50 feet of a stream that Is 6 <br /> !eet�vlde�vould be reported as 50 ft(300 square feet), <br /> �7hls IS generaliy only appl:cab�e lf you are applyl�g(or a de minimis exemptlon und2r MN Rules 6420.042D Subp,8,oth ervalse enter"N/A" <br /> °Use Wettond Flonts ond Plvnt�ommunity 7'ypes oJMlnneso:a anG W'tsconsfn 3rd Ed.as moclified ln MN Rules 8420.pa0i 5ubp 2. <br /> SRefer to ivla)or Watershed and Bank Servkce Area maps ln M!V Rules 842Q,0522 Subp,7. <br /> Ef any af the above Identifled#mpacts have aiready occurred,identify which impact5 they are and the clrcumstanc�s assoclated <br /> with each: . <br /> �i <br /> PART FlVE: Applicant Sfgnature <br /> ❑ C�eck here If you are requesting a pre-aA�on consultatlon with the Carps and LGU based on the informaticn S�ou have <br /> Provic�g�J, Regulatory er�titles�allf not lnitlate a formal appllcatlon revlew ff thfs box Is checked, <br /> BY signature below,I atces;that the lnformatlon in thls apaklcation 1s camplete and accurate, i furtner attest that I possess th� <br /> authortty to undertake ihe work described hereln, <br /> ���� r1 <br /> +gnature: Oate; 4� ' `5- `� <br /> I t,ereby authorite <br /> `T�,S,� to act on rr.y behalf as my agent In the proce:_sing o�thls appllca:lon <br /> . and t urnlsh,upon request,sup�lernenta!Informatton In suppert of thls appi:catipn <br /> 'The terrty���mpatt"aa used in this Jofnt appltcatlon form fs a generlc term used for d(;closure purposes ta Identlfy <br /> ectivttfes that may requlre approval from ane or more regulatory agencEes. Por purgoses of this form(t Is no!meant to <br /> E�dicate whether or not those activktles may requlre mitlgation/replacement, <br /> Mlnnesota Interagency Water Resource App!lcation Forr�February Z014 <br /> Page S of 13 <br />