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ProM Name and/or Number: 1400 Brackesu Point Road <br />PAR i WOR: Ayuaatic Rez uaic7a Imlood' Summal y <br />R your proposea proJRT Involves a aireft or Int11Fi T impaR to an aquatic .esoarce (wetland, )aR., tri6eta.—r, etc.) laemay =..cM <br />impair[ In tRe tasle seiow. Incluse all anticipatea ImpaM, incluaing tRose expet'tea to Be te... per..rrr. Auden on ole.-Rcaa -vile= map, <br />aerial pnoto, ana/or arawing sRowing all of ine aquatic resources in tRe r.r.ject area ans tRe lac -den(,) vT LRc propa3cs Impacts. <br />®oei eacR aquatic resource on tRe map witn a reverence numser or ietter ans ia.niify tRe lm,z 6 rn tR� Tolle ming task. <br />Aquatic <br />Aquatic <br />1[cave.-- <br />Type of <br />c fill <br />Impat i <br />uufaaQIR Or <br />size of <br />Ugerali size <br />County. <br />licavafee [[] ( <br />, <br />I pai:E <br />Im �� <br />of Aquatic <br />Existing Plan. Community I ype(s) <br />Watershed, & <br />noted on <br />! e(we:l.nd, <br />"' <br />lake, tributary <br />e..sesete,dmin <br />or reme- <br />Permanent M or <br />pe <br />(=rr7) <br />Resource a <br />In lmpocc.,n:a' <br />Bank Service <br />overhega viewl <br />etc. <br />vegcra.n.n) <br />TemporaryI i l <br />(arm) <br />Area 5 <br />ncnncpin <br />No wetlands exist within the 12.72 -acre property. The property is bordered on <br />county; <br />�, .,ate att mat La v Muusw. v yr ta, a� <br />the cmt d by k -t-nka, h' -h Ircks a ,,atzma rr: ,E; 1s, tnu <br />watershed 20 <br />. <br />vicH,ity ut the pLuperty. <br />miVtTMCtro); <br />AS^ r <br />If impacts are temporary, enter the duration of the brrpacts in Says nen to tile 'r. For example, it protea with a temporary access IM that would be removed after 220 days would be <br />entered "T i220r. <br />%sp__ M in-. o....... a A—Z e. repormo n square icer lmpacts a—. rr o or Qr..rer smoulE N Fc -p-.,.— es an., Mona.., w Ale ":real 0.0! e.a c. i "awry impacts most 5. <br />..,.....ed in Enema fue:of kapact_nd rrea of bnp..., by Indicating in; ft Un...r Fe J knp5ct:lorr4 th. fkrwl......f the 7—m. fdknved by the... mrpecs m p.nenthesesi. Far <br />. purled that impacts 50 feet _f _ -!roars that Is b feet wide -1d be m;:= rted — 50 ft POO -aces f■et). <br />'This is 8enwallp onry applicable i(you are appM fora de minknis exempmn under MN Rules 8420.0420 SuEQ.8, otherwise enter '1117W. <br />use W—mr roma arae r.r.r crwnmen)ty +ypes 7-1- a u RFiscons- Wo 'co. as ma.mao n AIA Rules =20.0405 subp. L <br />'Rarer W 1114ior .rwrsned.na Ank+u......... maps ill Mn Mies. 0.mau o:p. ,. <br />if any of the above lUendfied impart have alreasy occurreu, )uentify wRIcR impacts tRey are ans the circumstances assoclatea <br />witR eacR: too impacts have occurred. <br />PART FIVE: Applicant signature <br />fided. <br />heck here if you are requesting a Pre-M)IiCatlon consultation with the carps and M0 !lased on tRe Information you nave <br />Regulatory entitles will not initiate a formal application review if this box Is checker. <br />By signature below, i attest tFiat tRe information in this application is complete and accurate. I further attest that I possess the <br />authority to undertake the work described herein. <br />.Si6flatllr c: Data: <br />10-13-17 <br />I hereby authorize Kjolhaug Environmental Services to act on my behalf as my aaenw in the processing of this application and wo <br />furnish, upon rquest, supplemental information in support of this application. <br />I s ne term 1mpatr as area In trim joint application tarn is a genetic term uses tvr t wicisure purposes to 10enufy <br />auuvates xMi may require approval tram one or more regulatory agencies. For purposes of alis term ft is not meant to <br />inelcate wnetRer or not those al!114R1Es may require malgatton/replacement. <br />Minnesota Interagency vvater resource Appilcadon Form February cult' Page c or.3 <br />