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SEP-16-1999 15�51 MINNEHHHA CREEK �ATERSHED 61247106Q2 P.02���
<br /> ., �: �-°�
<br /> COMBIAI�A JOINT NO�'��+�CA,�'ION �'ORM- 'WATER R�SOC�RCE A�'�'LICATiON a�F�
<br /> Use this form to natif�/appty t4 the Minnehaha Creek W�ietshed Aisirict (MCVVb), their engitieering consultaltts, thc
<br /> X)NR, and tiie Hennepin Conservation District of a proposed water/wetland project or work �vlzicii may fal! within tiiei
<br /> jurisdiction.. These agencies should ad�ise you of thcir jurisdiccion or perrnit requircments witt�in lQ days. Fill out d�is
<br /> form completcly mail a eopy, with plan, ma�s, etc... the MCWD, Crray Freshwater Ctnicr, Navarre, 2500 Shadywood
<br /> Road, Suite 3'7, E�celsior, MN 55331. Keep x copy for your records. YOU MUST Q$TAIN AL�, ILEQU�RED
<br /> AUTxo�.rza�orrs BEFo� $��rnrn,rrr�r�oruc.
<br /> 1. Applicant's N �(Lesl,Fi t,M.T.) Phonc Na. �
<br /> �c.ltir-�,��D a�. o.,s 2. �I Z.. �G(`i J 3��'�
<br /> Addr ss(Street, Et�'D, Bo�C#, City,Sj�te,Zip) �� . �c�� ) ����
<br /> 1�� � �.�r�,���-e., �y�r� ,i��
<br /> 2. Location of pmposed project(Attach drawing w/directions to site);
<br /> GOUNT'Y Q'CR SEC'CCON(s) SEGTION(s) TdWNSHiP�,s} RANC,�(s) Lot, Bloclq�����., �,�r�
<br /> wA�"Er:�f-�;�:c U�:.�`�
<br /> PRO�CT AnDRESS: �Gn��,, t. a. a v-�.
<br /> 3_ LENGTH OF SHORE AFFEC�D(in feeQ: VOLU1v��F FILL OR EXCAVAT[ON{Cubic ya,-c��p � ����
<br /> � A.R.EA FTY.LCb OR�XCAVATEA[S Acres,OR Square Fee�.
<br /> y... , �... �. ; ,:� r.:....
<br /> 4, TYPE OF PERMIT BEING.A�'P�.IEA FOR: (Check all that apPZY)= q.�.'�.� ";�;�, ; ��^ `.,.�
<br /> p STORMWATER MANAGEtv�NT PLAN ❑ FL.00DPLA,iN AI,TERATION ❑ WLTT.ANb ALTERATiON
<br /> ❑SH02ZELINE 1MrikOVLrr�Nr pS'rpRM SEWER OCri��,t,S p ExCAVAT�ON (ARE�7r,�NG)
<br /> � d.p WII..DLIFE
<br /> b,pSANDBLANKET ❑ICE kmG�REMGVAL b.� NAVlGATIbI�!
<br /> a�RETAINING WALL c.❑ �Y��NGINEER�NG
<br /> r ❑BRID�E& CULV��t7'C�tOSS1NGS
<br /> 41'HL�R (T7ESCRIBE) I�.�f aC.�. L�a � �>��� _ ._
<br /> 4a. APPLICANT'S �PRESENTAT[V�:(Liceosed Con�actor,Engineer, etc_..) InctudE name,addtess Sc phonc number.
<br /> ..�. ..
<br /> � / : �'
<br /> ""V � �"1'�•� ��G �� �� ZI`� :�/� �d.�,� ��,c.✓�� ����'.'�
<br /> 5. PEZO)�CT P�RpOSE(why tis Lhis project needed-whal bcnefits wiil i[provide?)
<br /> ����+-► , C/C`• /J C�w�r�1r'��s /-� �{G�v+ �,.,ti7Clc{� �'�� �,(�✓�C,1'�� �'/�-,f.r ,J��
<br /> 6, ALT'ERNA"I'IVES (describe any othcr sites or methods that cou d be�used to achieve t��e purpase of your projea wlul� avoid"sn�
<br /> or minimizing watcr/wctland i�mpacts. Attach additionaI shcess, if needc�.
<br /> 7. DAT'�S; Proposed stari of activity: �,. ' �^-v c� �� Proposed completion: � ��� �
<br /> (Identify any completed woric on attached drawin�)
<br /> 8, NAMES & A.DDRBSSED OF PJ7�OI PROPERTY QWNERS{A ach IiSt1 if more)
<br /> ✓�/';-.... �...,� C.,s'�, �/�������-Ql` 1 �8�' �4�"e�T��.�-L i+�'�e. .�'�. �G
<br /> cI n. d��.. g, 4� r� � c1 rt « �-�e� ,S'., �"���
<br /> y � 1,�� _ rt
<br /> 9. ERMITS EIAV�S��N REC�I'VEU (R)OR APPLIE k'O!�(A)FffL(7M: D ARMX COR17S OF F..NCist
<br /> CpiJ1J'T'Y,� CITY •, MN POLi.tlTiON COI�TTR�OL AGEN�Y
<br /> I hereby notify tkic rccipiants of this fonrrf of the project pcoposed l�ercin a,nd req,uest [be advised of any pernuts or atl�er
<br /> deternunations concerning this p�rv,ject that i must oblain. I nnderstand that pt9oceeding with worfc before all r�quired authorizatiar
<br /> are oblained may be subjeet tq Federal, State and/or locat administrative, civil andlor�zimina penalties�
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<br /> Signature of Pe n Propasing Prpject or Agent �ate
<br /> TOTa� �.�2
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