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<br />Minnesota Interagency Water Resource Application Form February 2014 Page 3 of 11 <br /> Project Name and/or Number: 22-0486.00 David Held <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 />Applicant/Landowner Name: David Held <br />Mailing Address: 20225 Meadowvale Road Elk River, MN 55330 <br />Phone: 612-865-6622 <br />E-mail Address: dkheld85@gmail.com <br /> <br />Authorized Contact (do not complete if same as above): <br />Mailing Address: <br />Phone: <br />E-mail Address: <br /> <br />Agent Name: Sierra Cotter - Bogart Pederson and Associates Inc. <br />Mailing Address: 13076 1st Street, Becker, MN 55308 <br />Phone: 763-270-6151 <br />E-mail Address: scotter@bogart-pederson.com <br /> <br />PART TWO: Site Location Information <br />County: Sherburne City/Township: City of Elk River <br />Parcel ID and/or Address: PID No. 75-00119-1400 <br />Legal Description (Section, Township, Range): Section 19, Twp 33 Range 26 <br />Lat/Long (decimal degrees): N45.336973 W93.614444 <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): 10.9 Acres <br /> <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 />Proposed driveway access for potential split <br /> <br />Page 13 of 46