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'i iVA-026620-03B (V.2.02 for MS WORD) 08/12/04 '~ Minnesota Local/State/Federal A lication Form for Water/UVetland Projects ,® For Internal Use Only A lication No. Field Office Code Date lnitial A lication Received Date initial A lication Deemed Com lete PART t: BASIC APPLICATION "" "See HELP" directs you to important additional. information and assistance in Instructions, Page 1. - 1. LANDOWNER/APPLICANT CONTACT INFORMATION (See Flelp I) Name: City of Roseville -Debra Bloom, City Engineer Phone: 651-792-7042 Complete mailing address: 2660 Civic Center Drive Roseville, MN 55113 lA. AUTHORIZED AGENT (See Help IA) (Only if applicable; an agent is not required) __ Name: Kelly Bettendorf, Associate Phone: 651-490-2146 Complete mailing address: SEH, Inc. 3535 Vadnais Center Drive, St. Paul, MN 55110 __~ 2. NAME, TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IMPACTED (Attach Additional Project Area sheets if needed) Name or LD. # of Waters Impacted (if applicable; if known): Lake Owasso (250W) (Check all that apply): ®Lake ^River ^Wetland type ®1 ^ 1L ^ 2 ®3 ^4 ^ 5 ^ 6 ^ 7 ^ 8 Indicate size of entire lake or wetland (check one): ^ Less than 10 acres (indicate size: } ^ 10 to 40 acres ®Greater than 40 acres 3. PROJECT LOCATION (Information can be found on property tax statement, property title or title insurance). Project street address: South Owasso Blvd Fire #: City (if applicable): Roseville '/a Section: NE Section: 1 Township #: 29N Range #: 23W County: Ramsey Lot #: Block: Subdivision: Watershed (name or #) Mississippi R (20) Attach a simple site locator map. If needed, include on the map written directions to the site from a known location or landmark, and provide distances from known locations. Label the sheet SITE LOCATOR MAP. 4. TYPE OF PROJECT: Describe the type of proposed work. Attach TYPE OF PROJECT sheet if needed. ~! Realignment of South Owasso Blvd and creation of storm water treatment ponds 5. PROJECT PURPOSE, DESCRIPTION AND DIlVIENSIONS: Describe what you plan to do and why it is needed,. how you plan to construct [he project with dimensions (length, width,. depth), area of impact, and when you propose to construct the project. This is the most important part of your application. See HELP S before completing this section; see What To Include on Plans (Inswctions, page 1). Attach PROJECT DESCRIPTION sheet. Footprint of project: 0.91 acres excavated for ponds and 0:02 acres filled for roadway realignment. 6. PROJECT ALTERNATIVES: What alternatives to this proposed project have you considered that would avoid or minimize impacts to wetlands or waters? List at least TWO additional alternatives to your project in Section 5 that avoid wetlands (one of which may be "no build" or "do nothing"} and explain why you chose to pursue the option described in this application over these alternatives. Attach PROJECT ALTERNATIVES sheet if needed. See Section 3.0 of the attached permit application _ 7. ADJOINING PROPERTY OWNERS: For projects that impact more than 10,000 square feet of water or wetlands, list [he complete mailing addresses of adjacent property owners on an attached separate sheet.. (See HELP 7) This information wilt be provided upon request, if deemed necessary. - - 8. PORTION OF WORK COMPLETED: is any portion of the work in wetland or water areas already completed? ^ Yes ®No. if yes, describe the completed work on a separate sheet of paper labeled WORK ALREADY COMPLETED. (See HELP 8) • 9. STATUS OF OTHER APPROVALS: List any other permits, reviews or approvals related to this proposed project that are either pending or - have already been approved or denied on a separate attached sheet. See HELP 9. • 10. I am applying for state and local authorization to conduct the work described in this application. I am familiar with the information contained in this application. To the best of my knowledge and belief, all information in Part I is true, complete, and accurate. I possess the authority to undertake the work described, or I am acting as the duly authorized agent of pplicant. ,; /2 23~o S t Signature of applicant (Landowner) Date Signature f agent (if applicable) Date ° This block must be signed by the person who desires to undertake the proposed activity and has the necessary property rights to do so. If only the Agent has signed, please attach a separate sheet signed by the landowner, giving necessary authorization to the Agent. Minnesota Local/StateJFederal Application Forms for Water/Wetland Projects Page 1