Mn Wetland Conserv. Act Notice of Application-2016

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Project Name and/or Number: 3590 North Shore Drive �� PART ONE: Applicant Information � If applicant is an entity(company,government entity, partnership, etc.),an authorized contact person must be identified. If the applicant is using an agent(consultant, lawyer,or other third party)and has authorized them to act on their behalf,the agent's contact information must also be provided. Applicant/Landowner Name: William Abbot—The Broadway Group, LLC Mailing Address: 408 Parkers Lk Rd#112,Wayzata, MN 55391 Phone: 612-751-7177 E-mail Address: williabbott@gmail.com Authorized Contact(do not complete if same as above): Mailing Address: Phone: E-mail Address: Agent Name: Ben Carlson Mailing Address: 26105 Wild Rose Lane Shorewood, MN 55331 Phone: (952)-401-8757 E-mail Address: ben@kjolhaugenv.com i PART TWO: Site Location Information I County: Hennepin City/Township: Orono I I Parcel ID and/or Address: 0811723340062 Legal Description(Section,Township,Range): S8 T117N R23W Lat/Long(decimal degrees): , Attach a map showing the location of the site in relation to local streets,roads,highways. I Approximate size of site(acres)or if a linear project,length (feet): 0.31 acres � IIf ou know that our ro osal will re uire an individual Permit from the U.S.Arm Cor s of En ineers ou must rovide the I � Y Y P P q Y P B� ,Y P names and addresses of all property owners adjacent to the project site. This information may be provided by attaching a list to your application or by using block 25 of the Application for Department of the Army permit which can be obtained at: � I http;fLwww.mv�usace.arm �.mil Portals/57/docs/re�ulatory/RegulatoryDocs/engform 4345 2012oct.pdf i I � � PART THREE: General Project/Site Information � I If this application is related to a delineation approval,exemption determination,jurisdictional determination, or other I � correspondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. i � � Describe the project that is being proposed,the project purpose and need,and schedule for implementation and completion.The � project description must fully describe the nature and scope of the proposed activity including a description of all project elements I that effect aquatic resources(wetland, lake,tributary,etc.)and must also include plans and cross section or profile drawings I showing the location,character, and dimensions of all proposed activities and aquatic resource impacts. I I iMinnesota tnteragency Water Resource Application Form February 2014 Page 3 of 11