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Project Name and/or Number: 3590 North Shore Drive <br /> PART FOUR: Aquatic Resource Impacti Summary <br /> If your proposed project involves a direct or indirect impact to an aquatic resource (wetiand, lake,tributary, etc.) identify each <br /> .impact.ia�he table beloaa�.G�clude.aU an.ticipa-ted.ir.r.�pacts,:ulclirdi�g�ku»se�x�ec,ted�o be ter.x►por•at�..i4ttact�an�ver.taead�ieaai <br /> map, aerial photo, and/or drawing showing all of the aquatic resources in the project area and the location(s) of the proposed <br /> impacts.Label each aguatic resource on the map with a reference number or letter and identify the impacts in the followin,g 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 Impacri Aquatic and Bank <br /> (wetland,lake, � � E�)f� <br /> overhead view) remove or Temporary Resource 3 � Service area#�� <br /> tributary etc.) Impact Area4 <br /> . uege#atioxa.j . .(7�1 oflmpactArEaS <br /> =If impaC#s are'temporary;enter"the duration o#the impacts in days next'to'Che"T'". For exampie,a projed wT�h atemporary access fiU'Chat <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 6e reported as acres and rounded to the <br /> nearest 0.01 acre. Tri6utary 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 Howline 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 wov{d be reported as 54 ft E30E}squarefeet}. <br /> 3This is generally only applicable ifyou are applyingfor a de minimis exemption under MN Rules 8420.0420 Subp.8,otherwise enter"N/A". <br /> �1ise iNetland Plvnts and PlantGomm�r�ity�yper of Minnesoto and�Nisconsfn 3�fd.asmodi#ied�n�vli�l Ru�es 8420.c344fl5 Subp.2. <br /> SRefer to Major Watershed and Bank Service Area maps in MN Rules 8420.052�5ubp.7. <br /> If any ofthe above identified impacts have aiready occurred,identifywhich impacts they are and the circumstances associated <br /> with each: <br /> �PART•FIVE: Applicant Signature <br /> ❑ Check here ifyou are requesting a ere-application consultation with the Corps and LGU based on the information you have <br /> pro�r'tded. Regula�ory entities wi1E rtot initiate a�ormal a�rplication review if this box is checked. <br /> By signature below,f attest that the information in this application is complete and accurate. �further attest tfiat I possess the <br /> authority to undertake the work described herein. <br /> "7ti�, J�i'�� �'� C.'--�'�-� �� <br /> � �gnature: � ,i' . ,I ��� !/�� .-�-� Y".4'i► .io. _ Date: �5/9/2'0"1� <br /> // `i v ,!.(/�/ v,, � • � - <br /> �--^'' / <br /> _� <br /> I hereby authorize to act on my behalf as my agent in the processing of this application and to furnish,upon request, <br /> supplemental information in support of thfs application. <br /> 1 The term"impact"as used in this joint application form is a generit term used for disclosure purposes to identify <br /> adivities 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 /> lVlinnesota lnteragencyliVaterResource Application Form February 2014 Page 4 of 11 <br />