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Project Name and/or Number: 1400 Bracketts Point Road <br />Joint Application Form for Activities Affecting Water Resources in Minnesota <br />PART ONE: Applicant Information <br />If applicant is an entity (company, government entity, partnership, etc.), an authorized contact person must be identified. If the <br />applicant is using an agent (consultant, lawyer, or other third party) and has authorized them to act on their behalf, the agent's <br />contact information must also be provided. <br />Project Name: 1400 Bracketts Point Road <br />Applicant/Landowner Name: James Jundt <br />Mailing Address: 42486 109t' Way, Scottsdale, AZ 85262 <br />Phone: <br />E-mail Address: <br />Authorized Contact (do not complete if same as above): Brian Benson, Coldwell Banker Burnet <br />Mailing Address: 201 E Lake Street, Wayzata, MN 55391 <br />Phone: (612)227-8629 <br />E-mail Address: bkbenson ebburnet.com <br />Agent Name: <br />Mailing Address <br />Rob Bouta, Kjolhaug Environmental Services Co. <br />2500 Shadywood Road, Suite 130, Orono, MN 55331 <br />Phone: (612)581-0546 <br />E-mail Address: RobBgkjolhaugenv.com <br />County: Hennepin County <br />Parcel ID and/or Address: PID 11-117-23-32-0020 <br />Address: 1400 Bracketts Point Road, Orono, MN 55391 <br />Legal Description (Section, Township, Range): SW '/4 Section 11, T117N, R22W <br />Lat/Long (decimal degrees): 44.953115, -93.558965 <br />Attach a map showing the location of the site in relation to local streets, roads, highways. <br />Approximate size of site (acres) or if a linear project, length (feet): 12.72 acres <br />PART TWO: Site Location Information <br />City/Township: City of Orono <br />See attached Figure 1 <br />If you know that your proposal 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 information may be provided by attaching a list to <br />your application or by using block 25 of the Application for Department of the Army permit which can be obtained at: <br />http://www.mvp.usace.army.mil/Portals/57/docs/regulatory/RegulatoryDocs/engform 4345 2012oct.pdf <br />PART THREE: General Project/Site Information <br />If this application is related to a delineation approval, exemption determination, jurisdictional determination, or other <br />correspondence submitted prior to this application then describe that here and provide the Corps of Engineers project number. <br />Describe the project that is being proposed, the project purpose and need, and schedule for implementation and completion. The <br />project description must fully describe the nature and scope of the proposed activity including a description of all project elements <br />that effect aquatic resources (wetland, lake, tributary, etc.) and must also include plans and cross section or profile drawings <br />showing the location, character, and dimensions of all proposed activities and aquatic resource impacts. <br />Future residential use to be determined. <br />Minnesota Interagency Water Resource Application Form February 2014 <br />Page 1 of 3 <br />