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,'VA-112620-Ot LOCAL -STATE -FEDERAL WATER RESOURCE PROJECT NOTIFICATION /APPLICATION FORM <br />Use this form to notify/apply to the U.S. Army Corps of Engineers, the Minnesota Department of Natural Resources, and your Local Government Unit <br />of a proposed water/wetland project or work which may fall within their jurisdiction. These agencies should advise you of their jurisdiction ~r permit <br />requirements within 45 days. Some LGU's may also require submission of their own application forms. Fill out this form completely and mail a copy, <br />with plans, maps, etc. to each of the agencies listed on the reverse of the form. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED <br />AUTHORIZATIONS BEFORE BEGINNING WORK. <br />AGENCY USE ONLY: LGU NUMBER.:. MDNR NUMBER: CORPS NUMBER: <br /> Applicant's Name (Last, First, M.I.) Authorized Agent, if any Area Code, Telephone <br /> Kennedy, James W. City of Roseville (61a 490-2221 <br /> Address (Street, RFD, Box Number, City, State, Zip Code) <br /> 2660 Civic Center Drive <br />II. •_ocation of proposed project (attach drawinq showing how to get to site) <br /> COUNTY QUARTER SECTION(s) SECTIONS(s) No. TOWNSHIP(S) No. RANGE(sl No. Lot, Block, Subdivision <br /> Ramse NTa 1/4 Il 29 23 <br /> FIRE No., BOX No., OR PROJECT ADDRESS NAME OF WATERBODY AFFECTED and NUMBER (IF KNOWN) <br /> Bennett Lake <br />III. ESTIMATED PROJECT COST: S S 3 , ~ O S . O O LENGTH OF SHORE AFFECTED (in feet): 2 0 <br />IV. ~iOLUME OF FILL OR EXCAVATION (Cubic Yards): (NOTE.• You may substitute dimensions) <br /> AREA FILLED OR EXCAVATED IS 0 Acres, OR Square Feet <br />V. TYPE OF WORK AND AREA (CHECK ALL THAT APPLY): ^ ACCESS PATH ^ BRIDGE r~ CULVERT ^ DAM <br /> C~CONSTRUCT ^ DRAIN ^ EXCAVATE ^ DoCK ^ RIPRAP ^ SANDBIANKET <br /> ^ FILL ^ REMOVE ^ REPAIR <br /> ^ LAKE ^ SHORELINE ^ WATERWAY ^ WETLAND <br /> OTHER (DESCRIBE): <br /> WETLAND TYPE(S) AND ACREAGES) PROPOSED TO BE FILLED/DRAINED: None <br /> Attach applicable drawings, plans, and ASCS crop photos. Include a description of any proposed compensatory mitigation. Important: Identify <br /> any disposal and borrow areas. Describe the work below: haw it would be done; what equipment would be used. <br />VI. PROJECT PURPOSE (why is this project needed--what benefits will it provide?): <br /> To provide a gravity overflow from Bennett Lake to Lake Owasso <br />VII. ALTERNATIVES (describe any other sites or methods that could be used to achieve the purpose of your project while avoiding or minimizing <br /> wetland/water impacts: Attach additional sheets, if neededl• <br /> A pump and force main system exists now but is becoming obsolete <br /> and expensive to maintain. <br />VIII. DATES: Proposed start of activity: Proposed comRletion: <br />6-1-96 7-1-96 <br /> (Identify any completed work on an attached drawing) <br />IX. ADJOINING PROPERTY OWNERS (Attach list if more than two) <br /> Name Address City State Zip <br /> Roseville Parks 2660 Civic Center Dr. Roseville MN 55113 <br /> a_nrf Rarraatinn <br /> <br />X. PERMITS have been received (enter an R) or already applied for (enter an A) from: A DNR A ARMY CORPS OF ENGINEERS A COUNTY <br /> TOWN/CITY A WATERSHED DISTRICT _ MN POLLUTION CONTROL AGENCY <br /> Has an archaeological survey of the project site been done? nO If so, by whom: <br />1 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 <br />this project that I must obtain. I understand that proceeding with work before all required authorizations are obtained may subject me to Federal, State, <br />and/or local adminisVative, civil and/or criminal penalties. <br />`G~ DATE: ! ` [ t~ <br />Signatur f Person Proposing Project or Agent <br />< < < PLEASE CAREFULLY READ AND COMPLETE BACK OF FORM > > > <br />