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JUN-20-2003 11:08 MINNEHAHA CREEK WATERSHED 6124710682 P.02i02 <br /> Permit# -219 <br /> Sendblanket Permit and Sand Source Exhibit Form <br /> FAST TRACK PERMIT <br /> MINNEHANA CIREEK WATCRSNED DISTRICT(MCWD) <br /> 18202 MINNWMNKA BLVD, Ph: 962-471-0690 <br /> DPEPHAVEN, MN 55391 , Pax;952-471-M2 <br /> I,4 1 J swa L✓i✓1. reside at al d Y�i✓L� ® �' J7'f ,fie <br /> (Property ownwi tAddtessi (City) <br /> i4& A -Q'S/:oMqueet approval to install a sandblanket on property described <br /> (stone,rip) z (Phone) '. <br /> as � -9f:9Y& <br /> located in O"ea Na <br /> ( o <br /> -111�yz -Da7a1&_ ' p� 'aa,�aa s) (oc�rn) <br /> (Properly ID 4(PIDIF]) PORTAMAMINU . <br /> X,have conbvLcted with , <br /> InPI <br /> R.MN iN 1..�_to install cl eann�sand from the <br /> following sourcc e Wm. rn u,���� 4 �,rr Ruoff /l7,s/, <br /> / (S�+PpIkA ) Imo•$) ...._ <br /> one) <br /> ❑ I will install the sandblanket from the following source <br /> (6upp� <br /> ( ems) (Cipr,6W9%AP) �J 0111-0) <br /> My shoreline Is feet and the dimensions of the proposed sandb(ardwt are: X <br /> Pno) <br /> X Sandblanket dimensions cannot exceed a length of W(or 60%of shoreline), <br /> (apaq MAdrhl <br /> a width of 10' and a depth of s-. 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, 1 agree and understand that the District may war the property at reasonable hours <br /> to conduct an inspection to determine whether the terms of the permit are being meL I further understand that <br /> if t violate the terms and conditions of the permit Mat is issued based upon this application, the District shall <br /> conduct a fletd tnspecdon of the project per MCWD Rule J, provided with this application. I understand the <br /> District will charge fees to cover the actual costa of field inspections, including irnrasitgalion 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 Districts actual costs are deemed to begin=ruing when the District <br /> issues notice of the vlola on to permittee. I have read and understand the MCWD Technical Guidelines for <br /> sandtplank <br /> !!e J'( <br /> taus ot.Proptrr>,►ons <br /> Su o e a ' sw to d e me on this til ,2021. <br /> n..;ary P►mrc <br /> V M <br /> Public <br /> b'Y Camnuziva FsWtK Jk 71,i005 <br /> A roved by: Dote <br /> D <br /> JUN-17 2003 <br />