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_ _ _ _ _ __ <br /> i <br /> � <br /> � Project Name and/or Number: 4035 Dahl Road <br /> i <br /> ' PART FOUR: Aquatic Resource Impact1 Summary <br /> If your proposed project involves a direct or indirect impact to an aquatic resource (wetland, lake, tributary, etc.) identify each <br /> impact in the table below.Include all anticipated impacts,including those expected to be temporary.Attach an overhead view map, <br /> aerial photo,and/or drawing showing all of the aquatic resources in the project area and the location(s)of the proposed impacts. <br /> Label each aquatic resource on the map with a reference number or letter and identify the impacts in the following table. <br /> Type of Impact Duration of County,Major <br /> Aquatic Existing Plant <br /> Aquatic Resource (fill,excavate, Impact Overall Size of Watershed#, <br /> Resource Type Community <br /> ID(as noted on drain,or Permanent(P) Size of Impact2 Aquatic and Bank <br /> (wetland, lake, 3 Type(s)in <br /> overhead view) remove or Temporary Resource 4 Service Area# <br /> tributary etc.) Impact Area 5 <br /> vegetation) (T)1 of Impact Area <br /> llf impacts are temporary;enter the duration of the impacts in days next to the"T". For example,a project with a temporary access fill that <br /> would be removed after 220 days would be entered"T(220)". <br /> �Impacts less than 0.01 acre should be reported in square feet. Impacts 0.01 acre or greater should be reported as acres and rounded to the <br /> nearest 0.01 acre. Tributary impacts must be reported in linear feet of impact and an area of impact by indicating first the linear feet of impact <br /> along the ffowline of the stream followed by the area impact in parentheses). For example,a project that impacts 50 feet of a stream that is 6 <br /> feet wide would be reported as 50 ft(300 square feet). <br /> 3This is generally only applicable if you are appfying for a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". <br /> °Use Wetland Plants ond Planf Community Types of Minnesota ond Wisconsin 3'd Ed.as modified in MN Rules 8420.0405 Subp,2. <br /> SRefer to Major Watershed and Bank Service Area maps in MN Rules 8420.0522 Subp.7. <br /> If any of the above identified impacts have already occurred,identify which impacts they are and the circumstances associated <br /> with each: <br /> PART FIVE: Applicant Signature <br /> ❑ Check here if you are requesting a qre-application consultation with the Corps and LGU based on the information you have <br /> provided. Regulatory entities will not initiate a formal application review if this box is checked. <br /> By signature below, I attest that the information in this application is complete and accurate. l further attest that I possess the <br /> authority to undertake the work described herein. �L � <br /> ��-Cs�. ��,`�•�� <br /> Signature: �' � ^� Date: 7/17/2017 <br /> ' � �N-'� �-- a�o ��-(,� R��s L��. <br /> 1-kc�eb�... ,,�•;o:Tte .,...,.... .�,,.�...�E.. ,..,.,.,��.�s.r , �es�- <br /> cb� , <br /> 1 The term"impact"as used in this joint application form is a generic term used for disclosure purposes to identify <br /> activities that may require approval from one or more regulatory agencies. For purposes of this form it is not meant to <br /> indicate whether or not those activities may require mitigation/replacement. <br />