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ProJect Name and/or Number; � — .. � <br /> i <br /> PART FOUR: Aquatic Resource lmpact1 Summary � <br /> if your proposed proJect Invofves a direct or lndirect fmpaci to an aquatic resource ;wetland, lake, trlbutary, �-tc.} Ident€fy each ! <br /> impact fn the table below, include ali antictpated Impacts, Including those expecCed to be temporary, Attach �n or�erheac vlew ?M <br /> map, aerial photo, and/or �rawing showEng aii o#the aquatic resources In the proJect area and the loca:lon(sJ cf the pro;�osed ; <br /> lmpacts. �abef each aquatic resource on the ma�x wtth a reference numaer or letier and[dentify the impacts ln tha following:able. <br /> - . �Aquatic TYPe of tmpact Duratlon of County,MaJor <br /> Aquatic Reaource (fiH,extavate, Im act Exlsting Pl�nt <br /> ID{as noted on Resource Type . � P OveraA Slte�f WatersF�•ed q, <br /> (�vetland,lake, dra2n,or vermanent(P) Site of Impact= Aqustic �ommunfty and Bank <br /> overhead view) remvve, or Temporary Resource � <br /> trlbuta�y etc,} a YRe{s)In� Servlce Area� <br /> vegetatlon; 4ra� �mp�c:Ared <br /> of lmpact Area� <br /> � <br /> l�f�mpacts are temporary;enter the d�ratlon af the Impatts{r days next to the"T", For example,a proJect��ulth a temparary aa:ess flll tha: <br /> would�e removea atter 220 days would be er,tered"7{220)". <br /> =i+�pacts less than 0.01 acre shouid be reported in square feet. fmpacts 0.01 acre or greater shaulQ be reported as atres antE rounded to the <br /> near�st O.Cl acre. Trlbutary impacts must be reported!n Ilnear 1'eei ol;mpact and an area ot Impact by Indlsating flrst the linear feet of Im��act <br /> aiong the fiowllne of the stream followed t�y the area impaCt In parenthesesJ. For example,a prnject that Impacts:0 feet of a stream that fs 6 <br /> teet wlde wvuld be reported as 50 ft(300 square feeE). <br /> SU�7hls ls generaily only appl:cable It you are applyf�g(or a de minimis exemptlon und2r MN Rules 6420.0420 Subp,8,otherv�Ise enter"N/A" <br /> se Wetlond Plants ond Alont�ommunity 7'ypes oJM/nneso:a and W'lsconsfn 3rd Ed.as modfffed fn MN ftules 8920,0405 Subp 2. <br /> Reter tc MaJor Watershed and Bank Servlce Area maps 3n MN Rules 8420,0522 Subp.7. <br /> Ei any oF the above Identifled impacts have already cccurred,Identify which Impacts they are and the circun�stanc$s assoclated <br /> w�th each: . <br /> �f <br /> PART FIVE; Appficant Signature <br /> ❑ Ci�eck here if you are requesting a r -a Iica lon consulkatlon with the Carps and lGU based on the infvrmaticn��ou have <br /> providgd, Re$ula;ary entltles wlll not initlate a formal applicatlon revlew if thfs box is checked, <br /> Sy sfgna±ure beiow,t atcest that the lniormatlon In thls apallcation Is complete and acc��rate, i furt:�er attest that i possess the <br /> authortty to undertake the work descrlbed hereln, <br /> ���� <br /> igr,ature: Aate; �� ' (�- �y <br /> I hereby authorize,� � � <br /> . and t urnlsh,upon request,�up�lernenta!Info at(onhnlsuppert af thls appe:paQp�sfng o�thls appllti:lon <br /> �The terrq"impact"aa used in this Jolnt appltcallon form is a generlc term used for dl;closure purposes ta(dentlfy <br /> activttfes that may requlre approvai from ene or more regulatory agenc3es. For purposes of ti�is form(t is noi meant to <br /> fndicate wheti�er or not those activlttes msy requlre mitigation/replacemen#, <br /> Minnesota Interagency Water Resaurce Applltation Forr�Febnaary 201q <br /> Page S of 13 <br />