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p ECSC YE <br /> NOV 0 8 2010 <br /> Ntinx <br /> Permit# I <br /> Sandblanket Permit and Sand Source Exhibit Form <br /> FAST TRACK PERMIT <br /> MINNEHAHA CREEK WATERSHED DISTRICT (MCWD) <br /> 18202 MINNETONKA BLVD. Ph: 952.471-0590 <br /> DEEPHAVEN, MN 55391 Fax: 952-471-0682 <br /> I, Stew. ?uO (� resideat 5503 t,alc­ e.J Dry <br /> (Property Owner) (Address) (City) <br /> mo 55 y 7-. q(_? 6-L33 request approval to install a sandblanket on property described <br /> (State,Zip) 4_(Phone) <br /> as J u/ 7'o,\)1c,aJ�n a. v( , located in 01^oAJc) <br /> Street address) Within the City boundaries) (County) <br /> G'j5-1� y-! on jLtV.�� _ �1u <br /> (Property ID#[PID#]) ,, (Lake) p (Bay) r j <br /> IZ1 have contracted with �U�t ('(i A Ok(J� y\ � S(�) cie64- k, <br /> (Name of Company) (Streetaddress) <br /> 6(C-e,16 6533 l ("S ) 1/2Y tYV to install clean sand from the <br /> (City,Sta�teZip) (Phone) <br /> following source [a!iWl A4u t,i i ctc{u `c <br /> (Supplier) (Address) (City,Zip) <br /> (Phone) S <br /> I will install the sandblanket from the following source <br /> (Supplier) <br /> (Address) hh (City,State,Zip) (Phone)) <br /> My shoreline is OV feet and the dimensions of the proposed sandblanket are: 2 J X <br /> xx (Length) <br /> (c^ ' X v Sandblanket dimensions cannot exceed a length of 50'(or 50%of shoreline), j <br /> (Depth) <br /> Width) <br /> a width of 10' and a depth of 6". If this project requires municipal approval or review, please attach <br /> documentation of the municipal approval with this application. j <br /> I understand that if this application is not completely filled out, or if I fail to submit the required exhibits, the <br /> application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. By <br /> signing this application, I agree and understand that the District may enter the property at reasonable hours <br /> to conduct an inspection to determine whether the terms of the permit are being met. I further understand that <br /> if I violate the terms and conditions of the permit that is issued based upon this application, the District shall <br /> conduct a field inspection of the project per MCWD Rule J, provided with this application. I understand the <br /> District will charge fees to cover the actual costs of field inspections, including investigation of the area <br /> affected by the work, analysis of the work, including the services of legal counsel and engineers, and any <br /> subsequent monitoring of the work.The District's actual costs are deemed to begin accruing when the District <br /> issues notice of the violation to permittee. I have read and understand the MCWD Technical Guidelines for <br /> sandblankets. -7 (/ <br /> ,b f 10 <br /> (Signature of Property w 73r) (Date) <br /> Subscribed and sworn to efore me on this �� da of ,20 j <br /> �"� [,*L MARY JEAN WHEELOCK <br /> o Public ARY PUBLIC-MINNESOTAc),mision EKpiroa Jen.91,2011 <br /> Approved by: Date 0 <br /> i <br />