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JUN-23-2009 10:31 P.03iO3 <br /> Permit#(Y-) - <br /> Sandblanket Permit and Sand Source Exhibit Form <br /> FAST TRACK PERMIT <br /> MINNEHAHA CREEK WATERSHED DISTRICT(MCWD) <br /> 18202 MINNETONKA BLVD. Ph: 932-471-0590 <br /> DEEPHAVEN, MN 55391 Fax: 952-471-0682 <br /> I,'i 1M, Fr` reside at /V 7S- D K VA'wa P,a Lo La ke <br /> n`PI3s O <br /> qsi 2X0- 2/0 2 �` <br /> �a �) (,___)� one) request approval to install a sandblanket on property described <br /> 8s ay%k4wa- located in 10 MM Ze'Xt c h <br /> on M- �� /rVrQ'� In I*Gly boundaries) (co <br /> k-(Pmpe*ID# ( ) V%-% ' <br /> ( ) <br /> J have contracted with k& &( - fl- C-A51 VX9 ,`1600 C/e54- L4 k-c . <br /> �XC$l�iot & X533 I of Company)�L V7y- 9WS5 to instau clean sand from the ' <br /> (cry.Su ) (Phone) <br /> following source 1'�1 YIr1 U.e S f V lcv <br /> Z _ ( oPPWeh (plddras ) qty.Zip) <br /> (Phone) <br /> ❑ 1 vW1 install the sandblanket from the following source <br /> (Suppler) <br /> (Add'ess) (city.state. ) <br /> (phone) " i <br /> My shoreline is 126 feet and the dimensions Of the proposed sandblanket are: lot <br /> X <br /> J (Length) <br /> X o Sandblanket dimensions cannot exceed a length of 50' (or 50%of shoreline), <br /> epm) (V�kh) � <br /> a width of 10' and a depth of 60. If this project requires municipal approval or review, please attach <br /> documentation of the municipal approval with this application. <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 flees 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 pe I have read and understand the MCWD Technical Guidelines for <br /> sandblanktts. <��L <br /> ..,I <br /> (Sgnawre of Owner) (Daw) <br /> Subscri nd swom to before me on this day of •,u�.C,. , 20 Q <br /> Thoffm C. NIMm <br /> Notary Public <br /> mliviellft <br /> &&I&"E9ka�rurry fit.2012 <br /> Approved by: p-7-77 <br /> 6 2j p' <br /> REC. <br /> JUN 17 2009 <br /> TOTAL P.03 <br />