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Project Name and/or Number: 4035 Dahl Road <br /> PART ONE: Applicant Information <br /> If applicant is an entity(company,government entity,partnership,etc.),an authorized contact person must be identified. If the <br /> applicant is using an agent(consultant, lawyer,or other third party)and has authorized them to act on their behalf,the agent's <br /> contact information must also be provided. <br /> Applicant/Landowner Name: JHG Properties, LLC,Jim Gilbert <br /> Mailing Address: 12700 ANDERSON LAKES PARKWAY, EDEN PRAIRIE MN 55344 <br /> Phone: 612-790-7077 <br /> E-mail Address: jhgilbert@lawgilbert.com <br /> Contact(do not complete if same as above): Ben Carlson, Kjolhaug Environmental Services <br /> Mailing Address: 26105 Wild Rose Lane Sherwood, MN 55331 <br /> Phone: 952-401-8757 <br /> E-mail Address: ben@kjolhaugenv.com <br /> I <br /> Agent Name: <br /> j Mailing Address: <br /> I Phone: <br /> II E-mail Address: <br /> I'�i PART TWO: Site Location Information <br /> � County: Hennepin City/Township: Orono <br /> � Parcel ID and/or Address: 0711723140003 <br /> I Legal Description(Section,Township,Range): Section 7,Township 117N, Range 23W <br /> I Lat/Long(decimal degrees): � <br /> Attach a map showing the location of the site in relation to local streets,roads,highways. Ok <br /> I Approximate size of site(acres)or if a linear project,length(feet): 1.76 acres <br /> If you know that your proposal will require an individual Permit from the U.S.Army Corps of Engineers,you must provide the <br /> I names and addresses of all property owners adjacent to the project site. This information may be provided by attaching a list to <br /> your application or by using block 25 of the Application for Department of the Army permit which can be obtained at: <br /> http://www.mvp.usace.armv.mil/Portals/57/docs/reRulatorv/ReQulatorvDocs/engform 4345 2012oct.pdf <br /> PART THREE: General Project/Site Information <br /> If this application is related to a delineation approval,exemption determination,jurisdictional determination, or other <br /> correspondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. <br /> � <br /> Describe the project that is being proposed,the project purpose and need,and schedule for implementation and completion.The <br /> project description must fully describe the nature and scope of the proposed activity including a description of all project elements <br /> that effect aquatic resources(wetland, lake,tributary,etc.)and must also include plans and cross section or profile drawings <br /> showing the location, character,and dimensions of all proposed activities and aquatic resource impacts. <br />