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DEC-16-2092 12�37 MINNEHAHA CREEK WATERSHED 6124710682 P.03/08 <br /> �- 4 O <br /> COMBINED JOINT NOT�FICATION FORNI-WATER RESOURCE ApPLICA'ITON � <br /> Use this form tn notify/apply to tha innehAEfA Cteek Wate�ed Disttio� (MCWDj,l�eir engineerinB consultsnts,the <br /> . bNR,and the Hennepin Conservation Dis4rict of a proposBd wator/wetland project or work which may fall withiu tbeir <br /> jurisdiction.These agencies should a.dvise you of their jurisdietion or permit requiremeAte within 10 days.Fill out tlris <br /> fortn complete�y anid mail a copy,with plaa,maps,etc...to the MCWD, 16202 Minnetunka$lvd,Deephaven.,MN 55391 <br /> Keep a copy for your records. <br /> YOU MUST OBTAIN ALL REQiJYREA AUTHORTZATIONS BEFO� BEC�INNING WORK. <br /> 1.Applican 's �me asc,F' .t,M.I.) Phono No. <br /> f����T _F�OR„ D�.�,p . ���- S��L�.' <br /> A��S�S��t,��BoX#,��,,S�,Z�P,zq r� S�rn.E�sE �N E o � �ll� �S3q <br /> 2. T.oculion of proposcd projcct(Attach�awi�g w/directioas to site): <br /> COUN7Y QTR SBCTTON(s) SECITON(s) TOWNSHIP(s) RANGE(s) Lot,Block,Subdivision <br /> p o��n�ss: 2 / �res E crr�r: o °2� �� � � <br /> 3. LENGTH OF SHO1tE AFFBCTED(in 1`eet); VOLUME OF FILI.OR E7�CAVATION(G�bic yar�): <br /> AR�A FILLED OR V IS �►cres,OR Squarc Fcct. <br /> �,ly��ct. <br /> 4. TYp�OF PIIRMTT BfiING APPLffsD FOR (Check all that apply): <br /> (.�S't'ORMWATER MANAG�MI'sNT PLAN ❑FLOODPLAIN ALTERAI'ION ❑WELT.AND AI,TERATION <br /> O��a�n�ov��rrr ❑s�ro�s�our�nu.s �WRD�W�F�g N(DRLDC3ING) <br /> b.�SANDBLANKLT DICE RIDC'E REMOVAL b.�NAViQrA1TON <br /> c_ RET�V'TN(�WALL c. BIOENGINSSRING <br /> ❑BRIDGE�CULVERT CROSSATG� <br /> • OTHER(DP,SC�E) <br /> 4a. APPI.ICANT'S REI'RESENTATIYE:(Licdosed Coa�actor,Engineer,etc...) Include name,ad�ess&phoee numbear. <br /> I��ti�N 1��1Rav�NA/ �•(I(C� .cc�� f� �. t, I�lO SS � <br /> 5.PROJEG"f PURPOSB(why is this pmjcct nccded-what bencfits will it provide� <br /> �J i nl I � <br /> 6.ALTGRNA11VL5(dea�snbe aay other sices or methods d�ec eould be uaed co aehieve the pucposc of youc projcct while avoiding oc <br /> tninimizing watedwet{and impacts. Attach additiona!sheets,if needed <br /> /Vb'IU� . <br /> ?.DATES: Proposed start of activity: ���2$'��G�;� Proposed compieaou: �--/,�2003 <br /> (Id ' an oo leted wodc on attached dcawin <br /> 8. NANIES dt ADDRESSES OF ADJOiNWG PROPIIt1Y OWNSRS(Attaeh lise if a�re) { <br /> 9. PER'M1TS HAVE B RECfiIVL�D [R)OR APPLII3D i�OR(A)FROM: DNR A�tMY COaiPS OP IINGR <br /> COl7NTY CTTY MN POLLUITON CONT'ROL AGSNCY <br /> i h�by notity tbe recipiancs of this form of tlle project proposed 6erein and�quest I bo advisad of any p�mits or ot6�debeiminations <br /> coueerning chis proje�t thu f musc obtain.I�mderstand that p�oceed'mg with w�ic befa��t sll rrquitcd suthorizsbo�as arc obtamcd may be <br /> sub}ect to Federal,State and/or local adminisbrative,civil and/or criminal penaltieg. <br /> �����.-- 1�� -�� <br /> Si na of Person asin Pro'ect or �, <br /> �� /Va�fl t'/ �orr�Sq�/ ��1 J � <br /> � <br /> �-`" �;U 2 7 2002 <br />