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UtrnK�MENT OF NA-02670-04 <br /> '�4Q Rev. 4/Bt <br /> � �NATURAL RESOURCES <br /> LOCAL UNIT OF GOVERNMENT COMME(VTS <br /> _ � � PART B <br /> Section I (To be comp/eted by applicant) ' <br /> Name of A plicant Ad r s (SLreet, RFD, Box No., Ci State, �ip Code <br /> Char�es E. Olson �'��0 5hadywood Rd. �xcelsior, �n. 5533� <br /> Quarter Section(s) Section(s) Township(s) Range(s) Counry(ies) <br /> PROJECTLOCATION N2 21 117 23 Hennepin <br /> Project wiil affect: (name and number of lake, wetland, or watercourse) <br /> Lafayette Bay I,ake Minnetonka 25 , <br /> � <br /> I hereby submit this application for permit to: Si n • <br /> (mark proper box) g �ur f A licant Date <br /> 0 appropriate water �work in protected waters � v� <br /> 10-25-84 <br /> ----------------------------------- ------------------ <br /> Section II (To be completed by local unit of government) <br /> The following local unit of government comments and/or recommendations are submitted for consideration by the <br /> Department of Natural Resources�in the disposition of the referenced permit application. (YOUR RESPONSE MUST BE <br /> SUBMITTED TO THE DNR WITHIN 30 DAYS.)Water Appropriation Permit Applications are to be sent to the Central Of- <br /> fice, St. Paul,and Protected Waters Permit Applications to the DNR Regionai Office.SEE REVERSE SIDE FOR CORRECT <br /> MAILING ADDRESSES). <br /> �.�� a�-r�+..� G�jr7 �...�'`' �. � /Ql"",r,� <br /> �..� ,�.� �, � � � �,,,�,;,,� �,a.�.�, , <br /> ��1�C���.UU���1 <br /> t: � �...�.-. <br /> tj S: <br /> �� � <br /> ± ;(f�' NOV I I9�:� �� ` <br /> ,, , <br /> i li� . . - <br /> �� ��.�..;�' �;r Ei"i�E��.� <br /> t._ _ :r —:....._ .._ ._ . <br /> Was the proposed project field inspected by this local unit of government? �NO QYES (if Yes, give viewer'S name) <br /> Viewer's Name Title <br /> thorized Signature Title DBte Telephone No.(Area Code) <br /> � .. (�j��,) — <br /> Na of responding Soil and Water Conservation District, atershed District, Ciry or County <br /> Address (of the above named local unit of government) <br /> + (DNR — Qivision of Waters addresses on �ack) <br />