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Project Name and/or Number: 649 Ferndale Road, Orono—AE 14636 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. Applicant/Landowner Name: Matthew Hemsley Mailing Address: 4620 Moorland Ave, Edina, MN 55424 Phone: 612-303-6932 E-mail Address: matthew.s.hemsley@pjc.com Authorized Contact(do not complete if same as above): Mailing Address: Phone: E-mail Address: Agent Name: Ben Hodapp,Anderson Engineering of MN, LLC Mailing Address: 13605 ist Avenue North Phone: 763-412-4000 E-mail Address: bhodapp@ae-mn.com PART TWO: Site Location Information County: Hennepin City/Township: Orono Parcel ID and/or Address: 649 Ferndale Road Legal Description(Section,Township,Range): Si&2,T117N, R23W Lat/Long(decimal degrees): 44°57'S5.35"N/93°32'32.00"W Attach a map showing the location of the site in relation to local streets,roads,highways. Approximate size of site(acres)or if a linear project,length(feet): 2.9 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: httq://www.mvp.usace.army.mil/Portals/57/docs/re�ulatory/Re�ulatoryDocs/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. See wetland delineation report Minnesota Interagency Water Resource Application Form February 2014 Page 3 of 5