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MAY-28-z010 11:01A FROM: T0:65177279Z7 P.2 ,
<br /> ' NA-0266Z(FO]B (V.2.02 for MS WORD)9lI7R047
<br /> Minnesota LocallState/Federal A lication Form for Water/Wetland Pro'ects •
<br /> For Internal Use Only
<br /> Applicntion No. Field Otlica Code Date Initinl Applicntion Received Da1e initial Applicntion Deemed Complete
<br /> PART I: BASIC APPLICATION �D )n1.. ��
<br /> "Sa NELP"directs you a imporient additianal informeiion nnd esalsmrxe in Iruwc�ions,Page I. j/L/
<br /> I. LANDOWNGR/APPLICA�lT CUN"PACT IN�ORMATION(SeeXe! l
<br /> Namo: �h h (�MQ�� � Pl�one: � -7,$
<br /> Completc rosilittg address: �� � � k a�
<br /> lA. A I 7F.1) GL' ee He�1A) (Only ijnpplieable;an agen7ls no1 required)
<br /> Nmne: _.�k___or� _ � 9�, � Phone: �
<br /> Cnmplam mailing nddress: C Q y`
<br /> 2. NAME,TYPE AND SIZE OF PUBLIC WATEf2S or W '1' D4 D c �liliona! 'ro ect Area aheet if nee ed
<br /> Neme or l.D.�!of Walers Impacted(if appliceble;if known):
<br /> (Checic all lhat apply): �La1ce ❑River �Circular 39 Wadand type:❑ 1,❑ 1 L,[�2,[]3,❑4,�S,Q 6,❑7,❑$
<br /> Wetland pl�ot cammunity type': ❑shellow open weter,Q deep mnrsh,�shellow marsh,�]sedge meadow,�Fresh meadow,
<br /> ❑nzt to wet•meslc prelrle,�calcnreous fen,❑open bog or coniCerous bog,�shrut�cerr/older thicket,
<br /> ❑hardwoad 9wump or coniferous swomp,Q floodplein forast,�seasonnlly flooded basin
<br /> Indicate size of enlire lakn or uretland(cheek one): Q Loes than 10 ocrce(iixlice�e size:O ❑ 1010 40 ocres ❑Grealer lhnn 40 acros
<br /> 3. PROJECT LOCATIOT�f li�ormarion cun be ound on ro er Icu statement, ro ert�!ltJe or tille ln.ruronceJ:
<br /> Projectstreetnddress: / I ��M►�E o� A►14 1/► Firell:��Ciry{if e lic le: P+
<br /> '/.Section:Q Sectioa:r—� Township�: � �iangc�k: Counry:
<br /> Lot#:� Bloc&;��"d� Subdivisinn: Watersl�e nnme or 1�� UTM location:N� E �
<br /> Anuch e simple sile locnwr map. If naeded,include on tha mop wriuen dl�sc�ions�o Ihe slm from e known locntion or landmark,and
<br /> provide distances kom known locations. Lebel thc sheet SITE LOCATOR MAP.
<br /> 4. TYPE�F PRO�lE : Deuribe th of c wor A E F CT hc ' e
<br /> �
<br /> S. PRWECf PURPOSE,AESCRIPTiON A�'D DiMEfYS[01VS: Describe whnt you plan to do nnd why it is needed,Aowyou plan lo
<br /> conmuct the pro}ect wilh dimensions(length,width,depth),nrco of impeel,and wlxn you proposa to conswci the proJect. Thl�is lhe
<br /> mon Import9nt part of your nppllcation, See HELP S bclore compteHog lh�aeetian;see Whqt To Inelnde on Plana QnahucHone,
<br /> page 1). Attech AROJECT DCSCRIPTION sheet,
<br /> Footprinl of project:�actea or�squore feet drsined,filled or excavated.
<br /> 6. PFtOJECT ALTERNATIVES: Whal niternutives lo Ihis proposed projetl heve you considered lhat would uvoiJ or minimiu impects
<br /> to wellunds or weters7 Lisl al lewt'CWO oddirional aliernntives to your projcct in Section S tlmt nvoid wetlands(one of which may be"no
<br /> build"or"do nolhing"),and axplain why you ehose tn pursue thc option dcscribcd in Ihia applicalion ovor these allomntives. Attach
<br /> PRGU�'CTALT6RNATlYES shtei if needed.
<br /> 7. ADJOIIYING PROPERTY OWNERS: For projecls thnt impact more chan 10,000 squnre feet of wnfer or wetlends,list the oomplete
<br /> mailing oddreaxs of odjacent property owncn on en nttuched separete shcct. (Sce H�LP'1)
<br /> 8. PORTION OF WORK COMPLETED: la any portion of�he work in wetlend or watcr oroes alreudy complctcd? ❑Yoa QNo. !f
<br /> yes,describe Ihe completed work on a seperate sheet of paper labeled WORK ALREADY COMPLE7'ED. (See HELP A)
<br /> 9. STATUS OF OTHER APPAOVALS: List any other pertnits,rcviews or epprova(s roluled lo Ihis proposed project[hat ure either pendinR or
<br /> A�ve already beea epproved or dealed on n separele attechcd iheet. See HELP 9.
<br /> IQ. I um applying for etote artd locol authorlsetion to canduct the wark desc.�i6ed in lhis npptication, I an�familinr with tho infom�ation
<br /> eonlnined in lhis applicalion. To the b�t oFmy knowledgc und belief,ull informetion in Port 1 is tn+c,complola,and accurnte. I postes+
<br /> the oulhority W undertulce the work doscribed,or t um acting sa the duly sutl�orize gent of the epplicent,
<br /> � s./�/�
<br /> Slgnarure ojappllcan awner� Dar�7e T� Signature ojagent('I/�QPPlicoble) Dare
<br /> 'Chis bindc must be s�gned by fhe pcnon who dairea lo uederleke tlx propomed octiviry and hes�he nacaery pinperty righb lo do so. If only Iho Agrnt hm eigned,
<br /> plaue attech a xparnle ahcd aigned by lhe Im�downer,giring ncassary eulhoriration l01!u Agcnl.
<br /> �Se�WdlenAPlaetr wd Alanf Conurwx(Ilv ojMlnnuofo end{Ylreonrin(E�enr and Rtad,1997J ae modllled by the lio,rc a�'� g��o��ou t�
<br /> United Slalea Army Corpa of EoQloeera.
<br /> Minnesoia LocaVStarr/Federal Applicolian Fam�for Wmer/Wetlend Proja� MAY 2 II 7010
<br /> Pege 1
<br /> wa e S
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