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Projed Name and/ar Number. SERfi Z015-043-Q3--2445&2455 North Shore Drive,Orono
<br /> PART ONE: Applicant Information
<br /> If applicant is an entity(compa�y,government entity,partnership,etc.),an authorized cantad person must be identified. If the
<br /> appticant is using an agent tconsultant,lawyer,or other third party}and has authorized t�em to act on the(r behaff,the agent's �
<br /> contact information must also be provided.
<br /> � Applicant/landowner Name: ��Q��' ST E����r'� �--
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<br /> � Matltng Address: �� (�.S� /�O/Z.Ty1 ��D'�C �/✓G
<br /> � I; Phone: � ���fp/ �n/ S S ,�9/
<br /> iE-mati Address: 5 �e99. r.�/�, S 7'e�nfr afe/�9r,iH�/, �'o••� �
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<br /> , Aathortzed Contact(do not complet�ff same as above): Frank Svoboda—Svabcda Ecological Resources �
<br /> i MaiNng Address: 22752 Co Rd 7,Hutchinson,MN 55350
<br /> Phune: 612-384-7770 �
<br /> E-mall Acldress: franks@gpsinnovatitons.tom �
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<br /> PART TWp: Site Location Information �
<br /> , County: Hennepin City/Township: Orono !
<br /> ', Parcel ID and/or Addtess: Z4q5&2455 Narth Shore Drive (PID#0911723440008, 0009 & 001 l}
<br /> '� Legal Desc�iption{Section,Township,Range}: Scotch Pine Addition, Lats 1 &2 Blk l; A part of the NE '/, �
<br /> ' SE '/, SE '/+, Section 9, T117N,R23W,City ofQrona,
<br /> iHennepin County, Minnesota !
<br /> ; Lat/long{decimal degrees): laL 4d.95Z932(44'S7'1OS552"N)/Long.-93.58564(93'35'8.3040"W), �
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<br /> ; Attach a map showing the[ocat�on of the stte in relation to total streets,raads,highways.
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<br /> ; Approximate size of site{acresj or if a linear p�ojed,length(feet): 2 Acrea �
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<br /> If yau knaw that your propasa{will require an individual Permit from the U.S.Army Corps of Engineers,you must provide the
<br /> � names and addresses of all property owners adjacent to the project site. This infarmation may be provicfed by attaching a list to
<br /> your application or by using block 25 of the Appficati�n for Department of the Arnny permit which can be obtained at: �
<br /> http://www.mvp.usace.armv.mil[Portals157/dots/r�gulatorv/ReaulatorvDocs/enitform 4345 Z012o�t Qdf
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