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_TI IL ='=�-1'�'�;-� i�:�=t= f�lIhlhlEHHHH i=FEEI: I,:li--�TEF"-�HEL:� r,1�4�1�-�r=��' F'.�-��' '�-��'
<br /> -/ o �/J %
<br /> �pMBIlYEp ,TQ]N'T' NQ'TIF'�CATION FOR.1V�- VVAT`�R RES4URCE A�PLICATX�N �P� �
<br /> Use ihis �arm ta notifyla�ply�fi1►e Ivf anehaha_��re.�k�UVatershed Uistrict (MCWI]),their engineering consultattts, Lhe
<br /> rjN� and the F-ICttnepin Conservation T]is[riCt of a pmposed water/weiland project or wor�c which may fatl u�ithin thelr
<br /> j�risdiction:`.-"fliese agcn�cies`shouid advise'you��f tlieir jurisdiction Qr pemtit neyuiremenis wichin•�14 days::�Fill out this
<br /> foz�i i:oriipietely�iriai[ a�capY,`witb`plan;��►i�ps;=etc::. the'MCWD,Gtay Freskiw�r Center;Navarre,2500 Shady�vood
<br /> Road, Suite 37, Excelsior, M�*1 55331. Keep a copy for your r�cords. YOU MUST(3B�'AIN AI:�..REQ[J�tE1�
<br /> AUTHO1�iZA.'Tf ONS BEFQR�SEGINNINCr WORK _____ _. _�
<br /> {,;: ,r c.,. .;��.r.. .. . - . . . . . - 1 r . , . -. . .
<br /> 1. Applic�nt's Name(Last,First,M.I.} - Phone No_
<br /> `}�s��,:�''�i�r' ���:},', � �,�'��''�,�'n'BPv ': _. � �� �e-t�iJ�4 9,� :7�
<br /> Address (S�eet,RN�?:;�o,x#,Gity; Stat.'��A�r:=4 �:i�r4'��° �: s :� , ,: :-
<br /> a5 00 �fi� w� �Ad� ,��� ��.� M�..,.' ss�.�
<br /> 2_ Lacsrion of pr�oposed p%�ect(Attach drawing wldirccuous ta site): . _ �._... .
<br /> COUI�ETY ''" � •�Q'�'R SECT14N(s) SEC'�'ION(s) ��''I'OWNSHIP(s) RANG�(s) Lo� $lock, Stibcl�vis�on
<br /> ��r,,��<N �a 1�`� �.3 �
<br /> PROI��"I'A�DRESS:i�. �:. . ��: .. ;�;i�. , , ..� , , _ . , . ..
<br /> 3. �..ENGT�I OF SHO1�E AFFECTED(ir►�eet)'-"',@ VOLUME OF�[LL 0R EXCAVATIDN(G11bic yards):
<br /> AREA FILL�D OR LXCAVA�.1�1S Q Acres,O� � Square�'eeL
<br /> -�.:���ia,, j:. �:A�-: . .�- ' . , .��ii[�i; _.'7 , _.._. . ��I:� . .,,. '��-.-�� �rT7��. �... . . . ' , . - - . �
<br /> 4. 'I"YPE O��ERMIT BEING A.PI'LIED�OR:'�`(Check all that apply): ,- �' '�'' - �
<br /> _ - _ r ��:: �,- . _ , . c:, -. _ ry-. . _
<br /> ❑ STORMWATER MANAGEIvi�NT 1�LAN ❑F1�QODPLAIN ALT�TtATION 0 VYET�.AND AI-TERATION
<br /> [�SHOR.ELINE IMPROVEMEN"C. [�STORM S�'��ER OUT'FAI.LS � �XCAVATIdN (D�DGINGI
<br /> a.[jItIPRAP- , ,; - a.Q �VIT.I7LIFE
<br /> b. SAND�LAN�T :QIC��tIDGE REMOVAL b.0 NA�'IGATION
<br /> Q c: BIOENGT2�rEERTNG
<br /> c.[�RE'I'P.lNING�VALL �
<br /> n C]BRIDGE& CULVERT CROSSINGS
<br /> O'I'HER (DESCRIBE) t�� S u►� ca4 i vvr lat�.l2i'v 14t2..�!'.�
<br /> 4a. APPUTCANT'S REPRESENTATTVE' (Licensed Contractor,Engineer, ctc...) I�iciude n�eteT�pl�����er
<br /> �V'f v�W cQT�e2 ���.1,-t�l�"��ic'l� �i�k F-
<br /> 5, �RU�CT PURPOSE (wh_y is tlus project ner�led-what benefits will it pfoti1de?)
<br /> �/�m LJr �� /�!v�I?7 �L����� �� /"`•4�-l�l-t�' �- �-�s ,
<br /> 6_ Ai,TERNATIUES (describe any other sites or methods that couId 6e�sed to 3Chieve tlie p�u�4se� yrour pr�ject u r�������
<br /> or mir�imizing water/wetland impaets. Attach additior�al sheets, if needed.
<br /> /t/C �E
<br /> 7 DATFS Pr�posed st�rt of activfty� Proposed complction
<br /> (Idcntif�;� any completed work on attachcd dr,�wulg)
<br /> S NAMES& ADDRES�EII?/QF AD101N7NG ROPERTY OWNERS(Attach list ix mor�) �`-
<br /> �_`Su�t.tU.+ ,vr � fU.4va��°�,�,��/ � ' s�c�ta�.T /�u�J 1�s1�77 o�tJ
<br /> 9. PERIv1ITS HAVz BEEN R�CEIVED (R)OR APPI..TEB FpR(A)FR�M: DNR .�EtIvFY COR�'S OF �rJc1�.
<br /> CQU]��TY CITY MN POLLUTTON CQNTROL AGENCY
<br /> I hereb�� notify the recipicnts af tius fortn of the project proposed herein:�id request I be advised of any permi�s or other
<br /> detepfiuna'u I_ _ ' g this proje�t th�t I must obtain. I tutderstand that procecding«�it�t�vorlc before ail re�uircd 2uttlorizati�
<br /> are,'obXi � �i�y su .�ect to Pederal, Statc 2nd/or lacal administra[ive, civil andlor 'minat penalties_
<br /> '� 7 �9 9�
<br /> 5i turc ot e 5 n . oi�osing Project or Agent Dat _
<br /> TOTHL F'.�_��,
<br />
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