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°"'a"",,,,, � �.. � - <br /> ,����y <br /> WATER RESOURCE PERMIT APPLICATION FORM <br /> Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD)of a proposed project or work which may fall within <br /> their jurisdiction. Fill out this form completely and submit with your site plan, maps,etc.to the MCWD at: <br /> 15320 Minnetonka Blvd. Minnetonka, MN 55345. <br /> Keep a copy for your records. <br /> YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. <br /> 1. Name of each property owner: David Wohiwend and Meqan Wohlwend <br /> Mailing Address: 4526 Bluebell Trail S City: Medina State: MN Zlp: 55340 <br /> Email Addre9S hcwohlwend@grrzail.com Phone: Fax: <br /> 2. Property Owner Representative Information (not required) (licensed contractor, architect, engineer, etc...) <br /> Business Name: Stonewood, LLC Representative Name: Nate Mitchell <br /> Business Address: 153 Lake St E City: Wayzata State: MN Zip: 55391 <br /> Email Address nate@stonewood.com Phone: 612-462-4000 Fax: <br /> 3. Project Address: 1150 Pine View Dr City: Orono <br /> State: MN Zip; 55356 Qtr Section(s): Section(s): Township(s): Range(s): <br /> Lot: 3 Block: 1 Subdivision: Pine View pID: 28-118-23-42-0009 <br /> 4. Size of project parcel (square feet or acres): <br /> Area of disturbance (square feet): 6000 Volume of excavation/fill (cubic yards): <br /> Area of existing impervious surface: Area of proposed impervious surface: <br /> Length of shoreline affected (feet): Waterbody (& bay if applicable): <br /> 5. Type of permit being applied for(Check all that apply): <br /> � EROSION CONTROL ❑ WATERBODY CROSSINGS/STRUCTURES <br /> ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANAGEMENT <br /> ❑ WETLAND PROTECTION ❑ APPROPRIATIONS <br /> ❑ DREDGING ❑ ILLICIT DISCHARGE <br /> ❑ SHORELINE/STREAMBANK STABILIZATION <br /> 6. Project purpose (Check all that apply): <br /> � SINGLE FAMILY HOME ❑ MULTI FAMILY RESIDENTIAL (apartments) <br /> ❑ ROAD CONSTRUCTION ❑ COMMERCIAL or INSTITUTIONAL <br /> ❑ UTILITIES ❑ SUBDNISIONS (include number of lots) <br /> ❑ DREDGING ❑ LANDSCAPING(pools, berms, etc.) <br /> ❑ SHORELINE/STREAMBANK STABILIZATION ❑ OTHER(DESCRIBE): <br /> 7. NPDES/SDS General Stormwater Permit Number(if applicable): <br /> 8. Waterbody receiving runoff from site: <br /> 9. Project Timeline: Start Date: Completion Date: <br /> Permits have been applied for: City �County �MN Pollution Control Agency ❑ DNR �COE � <br /> Permits have been received: City—�County�MN Pollution Control Agency� DNR—�COE� <br /> By signing below, 1 hereby request a permit to authorize the activities described herein. I certify that I am familiar with MCWD <br /> Rules and that the proposed activity will be conducted in compliance with these Rules. I am familiar with the information <br /> contained in this application and, to the best of my knowledge and belief, all information is true, complete and accurate. I <br /> understand that proceeding with work before all required authoriza ' ns are obtained may be subject to federal, state and/or local <br /> administrative,civil and/or crimi enalties. <br /> �,..� 5- 1 Z . ��- <br /> Signature Eac roperty Owner Date <br /> � � <br /> IZ�•� i•���_1 - 1� l ; I':i��� I t�l� 1 <br />