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<br />JUN - 6 1994 <br /> <br />,Y.A...oU20-J'J LOCAl.. - STATE. FEDERAL WATFR RESOURCE PROJECT NOTlr:1CATlOr-.r I ApPLICATION FORM <br />UU ttli. form to notity/apply to the U.S. Army Corp. of Engino.ra. the Minnesota Oo~..rtmen( of Natural Resources, end your Local. Govorrvnent Unit <br />of . proposed wateOW.Uand project 01 woril which may fall within their jurisdiction. Thus _genci.. .hould ed'Vi.. you of their iYrisdietion or permit <br />requirements within 45 daY'. Some LGU'. may also require submission ot thoir own application forma. FiU out this form complotely and mail.. copy, <br />with plana, mapa, etc. to each of the Ilgonciell lilOted on tho reverse of tho form. Keep II copy for your recorda. YOU MUST OBTAIN A.LL REQUIRED <br />II>.UTHORIZA TIONS BEFORE BEGINNING WORK. <br /> <br /> <br />AGENCY USE ONLY: LGU NUMBER: <br /> <br />MDNR NUMBER: <br /> <br />CORPS NUMBER: <br /> <br />I. <br /> <br /> <br />Authorized Agent. if any <br /> <br />Aru Code. TolepnoM <br />l{p/';() .?-N / - ) tP t.,;2.. <br /> <br />z <br /> <br />It'v p,.- <br /> <br /> <br />330 <br /> <br />II. Location ot proposed project (enset, drtlwinc showing how to get to sito) <br /> <br /> <br />QUARTER SECTIONI.I SECTIONSl.) No. <br />..:7 <br /> <br />TOWNSHIPI.) No. <br />C> ~ ':S <br /> <br />RANGEl.) No. <br />~Y' <br /> <br />Lot, B!ock. Subdivision <br /> <br />Ill. <br /> <br />NAME OF WATERBODY AFFECTED end NUMBER (IF KNOWN) <br />E, , (/ '>~D <br />bbO,;-o LENGTH OF SHORE AFFECTED (in teet): <br /> <br />(NOTE: You ~y substitut. dimsn:;;onsl <br /> <br /> <br />i <br />I.u <br /> <br />IV. VOLUME OF FILL OR EXCAVATION ICubic Yardel: <br />AREA FILLED OR EXCA V A TED IS <br /> <br />Acrell. OR <br /> <br />Square Feet <br /> <br />'V. <br /> <br />TYPE OF WORK AND AREA ICHECK ALL THAT APPLY): <br />D CONSTRUCT D ~ ~XCAVATE <br />D.E!JJ. D REMOVE D REPAIR <br /> <br />o ACc::E'SS PATH <br />D 000< <br /> <br />DBIOOGE <br />DRIPRAP' <br /> <br />o CULVERT <br />D SANOlll.ANKET <br /> <br />DDMO <br /> <br />OTHER lDESCRIBE):!: JHt:>~:{r fhe <br /> <br />WETLANO TYPEIS) AND ACREAGEIS) PROPOSED TO BE FILLEDIDRAINED: <br />Attach applicable drawings, plans. and ASCS ClOp photos. Include a description of any proposed compensatory mitigation. <br />anv disoossl and borrow eres!!. Describe the work below: how it would be done; what equipment would be used. <br /> <br />D LAKE <br />dra/el;l"e -:+ <br /> <br />D SHORELINE D WATERWAY <br /> <br />e..t/.di'AJ,j po;..!/). <br /> <br />~ETLANO <br /> <br />Imoortant: Identify <br /> <br />VI. <br /> <br />d <br />PROJECT PURPOSE (why is this project needed-what benefits will it plollido?): <br /> <br /> <br /> <br />Jfr1;'c!.4 ! <br /> <br />o"O/-Pt't[) <br /> <br /> <br />ALTERNATIVES fd~scribe any other site or methods that could be used to achieve the purpose of your project while avoiding or minimizing <br />w.etJand/w8ter impacts: Anach edditional $heets, if neededl. <br /> <br />,~ <br /> <br />~ <br /> <br />VIII. DATES: Propoud start of activity: <br /> <br />q- I - Pi <br /> <br />Proposed completion: <br /> <br />S,4/1?e... <br /> <br />IX. <br /> <br />{Identify snv completed work on an ettached drawinol <br />ADJOINING PROPERTY OWNERS (Attach list if more ~an two) <br />Name ~. 11/; Ad~"J' h'J <br />. _e ,. /:1.(:- ,'~ '/ /~, <br /> <br />City <br /> <br />Stete <br /> <br />Zip <br /> <br />PERMITS have boen received (enter an fl) or already applied for lenter en ~ from: ...!i...- DNR / APMY CORPS OF ENCiJNEERS <br />TOWN/CITY WATERSHED DISTPJCT _ MN Pou.vnON COHTROl. AGfNCY <br /> <br />COUNTY <br /> <br />Has en archaeoloQieeJ survey of the projoct site beon done? <br /> <br />If 80, by whom: <br /> <br /> <br />I hereby notify the recipientl: of this form of the project prop~.d herein and requ.ct that I be advi..d of any permiu ot'" other detarmlnatioM <br />on.:.ming this project that I must obtain. I und..ntand that proceedlng with work before ell required authorization. are obtained may subject me 10 <br />dorel. Ste... endl local admin" v. a7d/O< 'minel panalti... <br /> <br />U .A ~./ I <br /> <br />Signature of Person Pro sing Project or Agont <br /> <br /> <br />DATE: <br /> <br />.s:-/3~flY <br />I <br />i <br />, <br /> <br />SE CAREFUl.l.Y READ AND COMPLETE BACK OF FORM> > > <br />