1997-01-23_AgendaPacket - Laserfiche WebLink

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Nr;~'D J.~,~ 1 .3 1a9~ ty,mQao-or (.OCAL -STATE - FfDERAL WATER RESOVRce PROJECT NoiTFlcAnav / APALICAnON FORM Uaa thin fans to notify/apply to the U.S. Army Corps o! Engineers, the Minnesota Department of Natvrd Resources, and your Local Government Unit of a Props aed water/wetland project or work which may fal! within their jurisdicdon. These agencies should advise you of (hair jurisdiction. ar permit requirements within 45 days. Some LGU's may dso require submission of their own eppfieedon tome. Fill oat-clue farm completely and mail a Dopy with plans, maps, etc. [o each of the agencies listed an the ravens of the forth. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. AGENCY USE ONLY: LGU NVMBER: MONK NUMBER: CORPS NVMBER: 1. Applic ant's Neme lLacT, First, M.LI Authorized Agent, if any Aree Codo, Telephone (zAN15E`{ COUt~'1`( ~~S ~ TitSl~1 b~ GKEVOtzY ~• MAc..K•_DIRF,GTOf~ (G1Z1 777.033 Address (Street, RFD, Box Number, City, State, Zip Coda) Zo I S VI+N DYKa; ST• }J • MA,PI,t~V00D Mu 5S I D' 11. Location of proposed project (etzach drawing ahawing how to pat to sitel COUNTY QUARTE SECTION(a) SECTIONS(al No. TOWNSF#tP(m# dto. RANG E(a) No. Lot, Block, Subdivision ~MSEY 5\~~~ Zg 3o z3 FIRE No., 80X No., OR PROJECT ADDRESS NAME OF WATERBOODY AFFECTED and NUMBER {IF KNOWN4 $N»L U,Y.~ ~G101~~l..~,>=yC_ <{I°sISWdL~ "{~U1D• ~jH02£VtE~M~ Sh1A1L~~ (v~-~3 III. ESTIMATED PROJECT COST: S ~f[~Q~O° LENGTH OF SHORE AFFECTED (in A©atl: 3~~ } fJ. VOLU0.1° OF FILL OR EXCAVATION (Cubic Yerdsl: (NOTc• Yau may sulu brute dimensions) AREA FILLED OR E9lc.NA $uf~i~~ 7OU G•Y• Acrae, OR Square Feet v. TYPE OF WORK AND AREA (CHECK ALL THAT APPLY): ^ Accr:ss PATH ^ BfbtH;E ^ CULVEtr ^ Dnrt ^ CONSTRUCT O DRAIN ^ EXCAVATE ^ Doat ^ RIPFiAP ~S.u+ostANICE7 ^ FILL ^ REMOVE ^ REPAIR ~,/ ysJ LAKE D SHORELINE ^ WATERWAY ^ WETLAND OTHER (DESCRIBEI: WETLAND TYPE(S) AND ACREAGES! PROPOSED TO BE FlLLED/DRAINEO: Attach applicable drawings, plena, and ASCS crop photos. Include a description of any proposed compensatory mitigation. Imoartanr. Iden[ifv env disposal and borrow erase. Describe the work below: how it would be done; what equipment would be used.. pt,Ac~M1~3i' Of SdND BLAi1K~T (r_," TEIIGIt. t,~y~.) oN FRDZLh1 U,Y~ SUp~A.GI; 1N pEStGNf•'lUD hC~.S t)SIUCa LUMP T2uGK-S ~ j~uBBEtL TtCt~A LOt+~f.R-•. VI. PROJECT PURPOSE {why ie this project needed-what bane fits will it providel): 7D -MYYFiUE A*~ µAiNT?,jN GLEb.V SANDY QUALffY of PUbUG SWIMMING ~A!_Fl AS P-~G10Nn1. P6.RaL.. C~Fhu SDhtD U~yE~ tN SaME AREAS VII. ALTERNATIVES (describe any other eitea or methods that could be used to achieve the purpoaa of your project while avoiding or minimizing wetland/water impacts: Attach additional ahaeta, if needed). tjpN>/ - EXI $11i]Cs 5\~IMT~tLI(p $~,~{ j VIII. DATES: ProPOaed start of activity: Fl$. \r7 11°J Z Proposed eompledon: ~EjS• 7A I l°~7 (I.AKfiWAftA ~ (Identify any completed work on an attached drawing) 1 IX. ADJOINING PROPERTY OWNERS (Attach fist if more then two) ~ Nemo I Address City ~ State Tip t~s+J{5 k PP'f'(Y STO\VERS 4z~ sua~(, t,~lc>r aL~lD• S(~a~rlaV M,~ 551710 I X. PERMITS have bean rece'rvad (enter an fi) or draedy eppGed for (enter an A) from: _ ONR _ Aat.rv Ct>RP5 OF EvGwEpts _ CouNry TowN/CITY _ WATFxsrtm Dts'rtacT _ MN PdlimOrt CoNTAOL AGENCY Haa en ercheaolagied survey of the project site been doneT NO If so, by whom: i twe6y na city the racipianta of dtis form of ttta project propoaad. Fwa'at and request tftat i ba advised of any permtta or otlw datamirta lions concemim, th:s project that I mtut obtain. I tadanLnd that procead'vig w(dt work before a0 required sutf.orttatforv era able frwd may subject ma to Federal, Sute, ardlor I admivs~ative, civi a cimind pandtles, v - ~ DATE: l - 3'~ Z Signature Parson ropoaing 'ac or Agent ~.< < < PLEASE CAREFULLY READ ANO COMPLETE 6.4CK OF FORM> > >