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_ � s , ' , �N��.. � NA-02610-01 LOCAL - STATE - FEDERAL WATER RESOURCE PROJECT NOTIFICATION /APPLICATION FORM Use this form to notify/apply to the U.S. Army Corps of Engineara,the Minnesota Department of Natural Resources,and your Local Government Unit of a proposed water/wetland project or work which may fall within their jurisdiction. These agencies ehould advise you of their jurisdiction or permit requirements within 45 days. Some LGU's may also require submission of their own application forms. Fill out this form completaly and mail a copy, with plans, maps, etc. to each of the agencies listed on the reverse of the form. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. AGENCY USE ONLY: LGU NUMBER: MDNR NUMBER:��-�(�v� CORPS NUMBER: I. Applicant's Name (Last, First, M.I.) Authorized Agent,if any Ajr1e2Codg, Tiepho�e02 Johnson Carl T. Stephen S artz ( installer ) p � `�7 9 Address(Street, RFD, Box Number, City, State, Zip Code) 3105 North Shore Drive �dayzata, �`ln. 55391 II. Location of proposed project(attach drawinq showing how to get to site) 3105 I�orth Shore Drive Orl Crystal tSS COUNTY QUARTER SECTION(s) SECTIONS(s) No. TOWNSHIP(s) No. RANGE(s) No. Lot, Block, Subdivision Her.nepin Re�. Land Survey rio . 0670 Tract B FIRE No., BOX No., OR PROJECT ADDRESS NAME OF WATERBODY AFFECTED and NUMBER (IF KNOWN) 3105 North Shore Drive Lake Ivlinnetonka, Crystal Eay III. ESTIMATED PROJECT COST: S 8 OOO LENGTH OF SHORE AFFECTED (in feet): 5O � IV. VOLUME OF FILL OR EXCAVATION (Cubic Yards): 2� (NOTE.• Youmaysubstitute dimensions) AREA FILLED OR EXCAVATED IS Acres, OR Square Feet V. TYPE OF WORK AND AREA (CHECK ALL THAT APPLY): D ACCEss PATH ❑ BRIDGE ❑ CULVERT ❑ DAM �I CONSTRUCT ❑ DRAIN ❑ EXCAVATE ❑ DoCK �9 RIPRAP ❑ SANDBLANKET Q FILL.: ❑ REMOVE �] REPAIR - . �1 LAKE �`il.SHOR�ELINE ❑WAT� ❑WETLAND OTHER (DESCRIBEl:R8j�31Y' Shore-line Ri Ra usin �oil �lnchors and Steel Plates. Re oc one wi e use o cover steel plates. WETLAND TYPE(S) AND ACREAGE(S) PROPOSED TO BE FILLED/DRAINED: Attach applicable drawings, plans, and ASCS crop photos. Include a description of any proposed compensatory mitigation. Impo►tant: Identifv anv disposal and borrow areas. Describe the work below: how it would be done; what equipment would be used. VI. PROJECT PURPOSE (why is this project needed--what benefits will it providel):TI'1@ PY'@S2T1't,f 121C� stone }',13S moved in- a d , , stro j.n �he u -land and mature t ee � Thi �o o ed Rip R �et�iq�� wi�� pr �rid� ice l�ad anc� errosion prQ�ec�ion, �e�ie�re�d better ��ian ie stone. A�so , "slope control" to specifications. , , VII. ALTERNATIVES (describe any other sites or methods that could be used to achieve the purpose of your project while avoiding or minimizing wetland/water impacts: Attach additional sheets, if needed). F1@ZCI Stone � however, tl'l18 WOU1.C7 TlOt provide the features sighted in Vl. VIII. DATES: Proposed start of activity: Proposed completion: 9/Z/95 11/195 � � (Identify any completed work on an attached drawing) IX. ADJOINING PROPERTY OWNERS (Attach list if more than two) Nam Address City State Zp R. O�lson 3��:5 North Shore Drive '�la.yzata P�n. 55'i91 R.�Hedlund�3 � �� „ �� „ X. PERMITS have been regeived (enter an R) or already applied for(enter an A)from: DNR _ARMY CORPS Of ENGINEERS _COUNTY TOWN/CITY A WATERSHED DISTHICT MN POLLUTION CONTROI AGENCY Has an archaeological survey of the project site been done? �'O. If so, by whom: 7t t I hereby notify the recipients of this form of the project proposed hereln and request tie advise�o� y permits or other determinations concerning this project that I must obtain. I understand that proceeding with work before all r�Fj^alired authorizations•�im btained may subject me to Federal.State, and/or local administrative, civd andlor criminal penalties. �� qG � �. � � �J �- �� Fc�`'C'��>9,��, 9 � G��1�Ci � � 0 �c DATE: � � Signature of Pereon Proposing P o' ct or Agent �� 9��.�`� � � , �,s r � - ,_ <<< PLEASE CAREFULLY READ AND CONIRLETE BACK OF FaR` >> �;<. t` 4�.�:,J l��,�si