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NA-026620-03B (V.2.01 for MS WORD) 02/]4/03 Minnesota Local/State/Federal Ap lication Form for Water/Wetiand Projects `'%~ ~ For Internal Use Only . ~~~~ no [cation No. Field Office Code Date Initial Application Received Date initial A lication Deemed Com Iete PART I: BASIC APPLICATION "See HELP" directs you to important additional information. and assistance in Instructions, Page 1. 1. LANDOWNER/APPLICANT CONTACT INFORMATION (See Help I) Name: Ramsey County Department of Public Works Phone: (651) 482-5230 Complete mailing address: ATTN: Terry Noonan, Project Manager ,3377 North Rice St., Shoreview, Mn 55126 lA. AUTHORIZED AGENT (See Help 1A) (Only if applicable; an agent is not required) Name: Complete mailing address: Phone: 2. NAME, TYPE AND SIZE OF PUBLIC WATERS or WETLANDS IlV)PACTED (Attach Additional Project Area sheets if needed) Name or I.D. # of Waters Impacted (if applicable; if known): (Check all that apply}: ®Lake ^River ®Wetland type ^ 1 ^ IL ^ 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: Fire #: City (if applicable): Vadnais Heights ~/< Section: NW Section: 31 Township #: 30 Range #: 22 ~ County: Ramsey County Lot #: Block: Subdivision.: Watershed (name or #) Mississippi .River (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. Re-establish Outlet for West Vadnais Lake 5. PROJECT PURPOSE, DESCRIPTION AND DIMENSIONS: Describe what you plan to do and why it is needed, how you plan to construct ttte 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 5 before completing this section; see What To Include on Plans (Instructions, page 1). Attach PROJECT DESCRIPTION sheet. See attached sheet Font}xint of pmject: acres or 720 square feet drained, filled or excavated. 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 [hat 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 attached sheet. 7. ADJOINING PROPERTY OWNERS: For projects that impact more than 10,000 square feet of water or wetlands, list the complete mailing addresses of adjacent property owners on an attached separate sheet. (See HELP 7) 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 the applicant. - ~' ~ ~, _ Signature o~`applicant (Landowner) Date I Signature of agent (if applicable) Date 'ss'Ca" `-''~~ ~ ,,~ <a 4 This block must be signed by the person who desires to undertake the proposed activity and has the necessary property rights to do so. lfonly the Agent had sued, please attach a separate sheet signed by the landowner, giving necessary authorization to the Agent_ '%: ~= `~'~i~<--'` Minnesota LocaUState/Federal Application Forms for Water/Wetland Projects -~> _ --:CF Page I r' ` n;;`,~.~~