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V. <br />DII <br />WM <br />If <br />xl <br />N A— 02622— 03 <br />Rey t: e'.5 <br />DEPARTMENT Of <br />NATURAL RESOURCES <br />PERMIT APPLICATIC ,1Lad "i <br />10 WORK IN PROTECTED WATERS WEflfi*1 U <br />IleCf.ufaflG DAM SAFETY) REGION VI <br />Please read instructions before attemptutq to complete this application IKATERS <br />OFFICE USE ONLY <br />P A NO <br />7 — <br />L'-]SWCD []C/C <br />O W D 0 LtSCOE <br />Aq)�ggllcant s Name (Last, First. M I I Authorized Agent (it appircable) Telephone N.� tiberaarrau <br />t"ETE�le$ r 0 oic-D ►zE Geo R617 <br />Address (Street, RFD, Box Number. City, State. Zip Code) <br />Lb+4nT LAer- LA,^Vb1A/6MOUM � AAAJ jS � <br />LOCATION OF PROPOSED PROJECT (BE SURE TO INCLUDE SKETCH SHOVVITJG Iiov. 1O GET TO THE- SITE) <br />Government Lot(s) <br />O ivyer S`e <br />No <br />Townshis)No. <br />Range(s) <br />ot. Block, SubdivisionISection(s) <br />NCL,S/V/J; <br />�tt4on(s) <br />o <br />If n <br />a 3 LA-) <br />A <br />Fire No.. Box No. or Peet Address <br />44 (PS f-aami 4A�r_ (,An/LVN' <br />County 1 �/1 <br />%'��Va�Gr-/AJ <br />Pr1,tectwdlaflect Lakr OWellanoor❑Watercourse <br />numlWrM/NNi57VAJk-,1- <br />Iaknowfneg <br />TYPE OF WORK PROPOSED (CHECK ONE) <br />IV. TYPE OF PROJECT (CHECK ONE) <br />excavate ❑ repair <br />>Csrorehne ❑ shore -protection ❑ obstruction ❑ dam <br />❑ fill C remove <br />--- channel ,:J harbor C bridge G other <br />• drain ❑ abandon <br />❑ sand blanket ❑ permanent dock Cl culvert (specify) <br />❑ construct ❑ other (specify) <br />❑ riprap C wharf <br />❑ install <br />ESTNNATED ""CT COST S %SQp <br />VI. LENGTH OF SHORELINE AFFECTED (IN FEET) <br />VOLUME OF MATERIAL FILLED OR EXCAVATED (IN CUBIC YARDS) •7tj <br />BRIEF EXPLANATION OF PROJECT: (EXPLAIN WHAT PROJECT CONSISTS OF AND HOW WORK WILL BE DONE) <br />l71eED4E. 70 cog/G y,c eus o F DA!?,4(i UNJ= <br />Or— SACk- 140E . 411 5PO/C A4A79414L- WI!! SE 4eMiiCtiff4� FA0V`N4 <br />61 T-E By SA re(l F Aovr� /ti Ae/ 41P6.4"✓c�l, '44e a. <br />PURPOSE OF PROJECT: (Explain thy this project is needed) <br />"r6 P/eoV/DE ti'^V14 4-1-70AIA-r._ A-Ccc5SS 7a F--)ctSr/A/4 r3oA7' 54,11,6 <br />ENtNOMMEIRAL IMPACT (Anticipated changes to the water and related lano resources, including unavoidable but detrimental effects) <br />$4-047 70e_i%A 3�- 7HE Z>eeob41 A/ <br />ALTERMATWES (Other alternatives to the action proposed) <br />/VOtJF_ <br />XN. I hereby make application pursuant to Minnesota Statutes Chapter 105 42 and all supporting rules for a permit to work in or affect the above named protected <br />water(s) in accordance with all supporting maps. plans. and other information submitted with this application The information submitted and statements made <br />concerning this application are true and correct to the best of my knowledge <br />n <br />STATE OF <br />COUNTY Of <br />l44a1.:xix&42.9— <br />Subscribed and sworn to betor me this <br />Srqn re <br />Agent <br />Date <br />�✓le <br />S1gn1ture o <br />see <br />Date <br />(j� .Hwx..,.v:+_ w�. r. axaH.....: �... �:.. <br />Distribution <br />day of <br />t 9 �(,[ b <br />White: <br />DNR <br />_ I •; ;: - R3E1'r=RLY THERAGLT <br />i Blue: <br />SWCD <br />My commission expires' <br />l ,r.ur NOTARY FUSLIC <br />..r,�1 HENNEPIN <br />Green <br />Watershed District <br />6'r L .,rmrs..0 Est r. <br />I <br />Goldenrod <br />Pink: <br />City or County <br />Army Corps of Engineers <br />Signatur t Notary <br />/r <br />Canary <br />Applicant <br />