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Project Name and/or Number; ,_,�D,j,�-^ ,�$__ <br /> PART ONE; applicant Information <br /> If applicant is an entlty(company,government entlty, partnershlp,etc.), an authorized contact person must be IdE�ntified, If the <br /> appllcant Is using an agent(consultant, lawyer, or other third party)and has authorized them to act on thelr beha f,the agent's <br /> contact information must also be provlded. <br /> Appllcant/landowner Name; � ' - - _ <br /> MaIIIngAddress: p p� B�� ��'� <br /> ���� <br /> Phone; jZ,.. S—�,� ,,,�� ` <br /> E•mail Address; � . <br /> Authorized Contact(do not complete if same as above); S� <br /> Malling Address; � <br /> Phone: ' <br /> E•mall Address; <br /> Agent Name; � <br /> Mailing Address; <br /> Phone, _L12—R''o2�- ������ <br /> GG l�i <br /> E•mall Address; <br /> �'d�+'�g*A�Q J�44�'�'N� <br /> PART TWO; Site Location Information <br /> County; _` City/Townshlp; � �A� . <br /> ���T— <br /> Parcel ID and/or Address; _ ,¢ <br /> ' �4�R.K.:.._..__._���J�..1�`1 �� <br /> legal Descriptlon(Sectlon,Townshlp, Range); t � <br /> Lat/long(declmal degrees); ' <br /> Attach a map showing the Iocatlon of the slte In relatlon t:o locai streets,roads,hlghways, �� <br /> Approxlmate slze of slte(acres) or ff a {Inear proJect, lengr,h (feet); p, �'4. Q���� ��_��, _ <br /> �-- <br /> If you know that your proposal wlll requlre an individual Permit from the U,S.Army Corps of fnglneers, yo,� rnust��ovlde the <br /> names and addresses of al)property owners adjacent to the proJect site, Thls Information may be provided by att�=ching a Iist to I <br /> your applicatlon or by using block 25 of the Applicatlon for Department of the Army permlt which can be ab�:alned a:: ' <br /> htto://www mvp.usace armv mll/Portals/57�docs/re�u'atorv/ReaulatorvDocs/enaform 4345 2012oct ta�f <br /> � <br /> i <br /> Minnesota Interagency Water Resource Applicatlan Form February 2014 <br /> Pa,3e 3��f 13 <br />