6.8. - 6.10. SR 08-17-1998 - Laserfiche WebLink

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LOCAL--STATE-FEDERAL WATER RESOURCE PROJECT NOTIFICATION/APPLICATION FORM Use this form to notify/apply the Minnesota Department of Natural Resources, the Army Corps of Engineers, a~d your Local Govemrnent Unit of a proposed water/wetland project or work which may fall within their jurisdiction. These agencies should advise you of their jurisdiction or permit requirements within 45 days. Some LGUs may require submission of their own application forms. This form is provided as a convenience and its use is optional. You may, if you wish, apply for permits or authorizations using standard agency forms. Fill out this form completely and mail a copy, with plans, mw ~. to each of the agencies listed on the reverse of the form. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AU. .~R.IZATIONS BEFORE BEGINNING WORa~. AGENCY USE ONLY: LGU NUMBER:. MDNR NUMBER:. CORPS NUMBER: I. Applicant's Name (First, Last, M.I.) / Authorized Agent, if any / Area Code, Telephone Contractor' Property Developers Company, At'm: Mr. HOmer Tompkins / Westwood Professional'Services, Inc. Attn: Mr. Rob Bouta / (612) 937-5150 Address (Street, RFD, Box Number, City, State, Zip Code) 9110 83'~ Avenue North, Brooklyn Park, MN 55445 / 7599 Anagram Drive, Eden Prairie, MN 55344 II. LOCATION OF PROPOSED PROYECT (ATrACH DRAWING SHOWING HOW TO GET TO SITE) County Quarter Section(s) Section(s) No. Township (s) Range (s) No. Lot, Block, Subdivision Sherburne (all) 35 33N 26W Fire No., Box No., or Project Name of Waterbody Affected and Number. (ifknown): Unnamed wetlands IlL ESTIMATED PROJECT COST: $ LENGTH OF SHORE AF?'E(;fP_;D (in feet): N/A IV. VOLUME OF FILL OR EXCAVATION (cubic yds.): (NOTE: You may substitute dimensions) AREA FILLED OR EXCAVATED IS 85,430 sf (1.96 acres ) of fill; 10,214 sf (0.23 acres) of excavation V: TYPE OF WORK AND AREA (Check all that apply): ACCESS PATH BRIDGE CULVERT DAM DOCK RIPRAP SAND BLANKET X FILL CONSTRUCT DRAIN X EXCAVATE REMOVE REPAIR F--] LAKE ~-~ SHORELINE ~ WATERWAY ~ WETLAND OTHER (DESCRIBE):. WETf..~ TYPES (S) AND ACREAGE (S) PROPOSED TO BE FILLED/DRAINED: See attached narrative. Att~ 'awings and plans. Include a description of any proposed compensatory mitigation. Im156rtant: Identify any disposal and borrow areas. Descnoe the work below; how it would be done, what equipment would be used: See attached narrative. VI. PROJECT PURPOSE (why is this project needed--what benefits will it provide?): See attached narrative. VII. ALTERNATIVES (describe any other sites or methods that could be used to achieve the purpose of your project while avoiding or minimizing wetland/water impacts: Attach additional sheets, if needed). See attached narrative. VIII. DATES: Proposed start of activity: Fall 1998 (identify any completed work on drawing). Proposed completion: 2003 to 2008, depending on market conditions IX. ADJOINING PROPERTY OWNERS (Attach list if more than two). Name Address 1. N/A City State Zip X. PERMITS have been received (enter an R), already applied for (enter an A), or will be applied for (enter a W) fi.om: DNR A ARMY CORPS COUNTY A TOWN/CITY WATERSHED DISTRICT A MN POLLUTION CONTROL AGENCY Has an archaeological survey of the project site been done? Yes If so, by whom: Archaeological Research Services (ARS) I hereby notify the recipients, of this form of the project proposed herein and request that I be advised of any permits or other determinations concerning this project that I must obtain. I understand that proceeding with work before all required authorizations are obtained may subject me to Federal, State, and/or local -aministrati_~, ciyil and/or criminal penaltie.~:s.. ___..___ Signature ~fPers~n Proposing [roject or ~en~~ <<<<<PLEASE CAREFULLY READ AND COMPLETE BACK OF FORM>>>>>