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Project Name and/or Number: SWlivan Property Joint Application Form for Activities Affecting Water Resources in Minnesota PART ONE: Applicant Information If applicant is an entity(company,government entity, partnership, etc.),an authorized contact person must be identified. If the applicant is using an agent(consultant, lawyer,or other third party) and has authorized them to act on their behalf,the agent's contact information must also be provided. Project Name: Sullivan Property Applicant/Landowner Name: Timothy Sullivan Mailing Address: 440 Brown Road South,Orono,MN 55391 Phone: (507)202-5363 E-mail Address: tmsullivann�d(a;gmail.com Authorized Contact(do not complete if same as above): Rob Bouta,Kjolhaug Environmental Services Co. Mailing Address: 26105 Wild Rose Lane, Shorewood,MN 55331 Phone: (612)581-0546 E-mail Address: RobB(n kjoll�au�env.com Agent Name: Rob Bouta,Kjolhaug Environmental Services Co. Mailing Address: 26105 Wild Rose Lane,Shorewood,MN 55331 Phone: (612) 581-0546 E-mail Address: KobB(n;kjolhaugenv.com PART TWO: Site Location Information County: Hennepin City/Township: Orono Parcel ID and/or Address: PID: 03-117-23-42-0012/Address: 440 Brown Road South,Orono,MN 55391 Legal Description(Section,Township,Range): NE '/ of NE '/ of SE Y of Section 3,T117N,R23W Lat/Long(decimal degrees): 44.970664,-93.568578 Attach a map showing the location of the site in relation to local streets,roads, highways. See Figure 1 Approximate size of site(acres)or if a linear project, length(feet): 2.5 acres If you know that your proposal will require an individual Permit from the U.S.Army Corps of Engineers,you must provide the names and addresses of all property owners adjacent to the project site. This information may be provided by attaching a list to your application or by using block 25 of the Application for Department of the Army permit which can be obtained at: http://www.mvp.usace.army.mil/Portals/57/docs/re�ulatory/Regulator�Docs/en�form 4345 2012oct.pdf PART THREE: General Project/Site Information If this application is related to a delineation approval,exemption determination,jurisdictional determination, or other correspondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. Describe the project that is being proposed,the project purpose and need, and schedule for implementation and completion.The project description must fully describe the nature and scope of the proposed activity including a description of all project elements that effect aquatic resources(wetland, lake,tributary,etc.)and must also include plans and cross section or profile drawings showing the location, character,and dimensions of all proposed activities and aquatic resource impacts. The home on the property is being repaired and the garage is being remodeled. The wetland delineation was completed to demonstrate compliance with municipal setback requirements. The wetland/deepwater habitat has a narrow wetland fringe and the landowner is also proposing to remove accumulated sediment from the isolated deepwater habitat. Minnesota Interagency Water Resource Application Form February 2014 Page 1 of 4