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AUG-16-2000 12�56 MINNEHAHA CREEK WATERSHED 6124710682 P.93iO3 <br /> . �: . <br /> SANDBLANKE'I'.,�ER�IIIIT & SAND SOURCE FXHYBIT FO�1VI <br /> . CREEK WATERSHED DISTRICT �- � <br /> � ' . � PERMIT�Qp..� <br /> I�1'��`f��✓��O/�� residj,ng al f-���u--�7��'�������'l�i��'��✓' SS39'� <br /> Pronarty 4wner Addness City,Stnbe,2in <br /> �. -�irci�//� , �/ �'a3 a� Oo� ar I'ID# <br /> wne Counry Township�Seclion,Renge (from ptopersy tnx s�etcFnent) <br /> own and oeoupy the above siMg,le family residencc and wish to iastall a sandblankel on <br /> /�1 r� —C.2ytrA�- <br /> `��`&�'Y Mintie�ice Por�b�e Dredging <br /> ❑ I have contrr�ct�d with ���� <br /> C����at uddt+ess <br /> to install elea.n sand from Eh� Eo114wing source: <br /> c�ty�state,�in phOtl4 <br /> wM �Nd«c.�a a- ��.T7.��B fL�,G� /�N $S�'2�� � • �/ 7 � or: <br /> SUpplier nddress ��honc � <br /> ❑ I will install the sandblanket myseIf fram the following source. <br /> supplier <br /> � <br /> add�'ass ph�ne <br /> If this projeet requires municipal appr�val or review, plc� attach documenl•alion of Ehc municipal appro��' <br /> with this applicalion. My shoreline is Feet and the dimcnsions of the proposed sandblankct ar�: <br /> �_ (Length) x �Q^ (Width) x�` (Dcpth). Sandblank�t dimensions cantlot exceed a <br /> [cngth of 50' (or 5096 0[shorclinc),a width of 10'and a depth of 6". <br /> ! underscand lhat if this application is not eompletely filled out, or if t fail to submit thc rec�uired exhibits <br /> the application is incocnplete and wil.l be ��etunlecL It will not be reviewed by MCWO staff until compl�te <br /> By signr.ng this application, I agree and understand tha.t�the Oistrict may enter the properEy at reasonablc <br /> hours to conduct an inspection to detcrmine whether the tcrms of•the permit are being met. I furthei <br /> understand'thaE if I viola.te the terins•and condifions of a permit that is issued based upon this application <br /> the Distriet shall conduct a field inspectiox�of t�hc project per MCWD Rule f, provided with this applicatior� <br /> �[ understand the Distriet will eh�arge fees to cover thc:actua[costs of ficld i�nspections, incluc�ing investigatior <br /> of the arca affectcd by thc work, analysis of the work, including tht services of [egal counsel and cn�ineers <br /> and a subsequent mo '�ng of the work. The l�istri�E's actual c�sls arc; deemed to begin acccuing w'hez• <br /> thc t tr' issue •ice of the violation to the permill�4. I have read arid understand Ihc Mc:WD Technica <br /> G �d � s f ndblankels. • <br /> . �' �� d� <br /> Sig atu op�rty owner, Dale <br /> �_.. <br /> S scribed and sworn to before me l•his �day of� 2�0�: <br /> : . �, �,�, � � . <br /> . <br /> � <br /> ary Public � . .. ..,;,�.,• .Woonr� � <br /> . �� <br /> Approv and Acc�pted by Date <br /> fames Hafner, Distxiet Technician <br />