MCWD Permit 19-386 Riprap - Laserfiche WebLink

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LAKE SHORELINE STABALIZATION PERMIT APPLICATION FORM MINNEHAHA CREEK WATERSHED DISTRICT (MCWD) 15320 MINNETONKA BLVD. Ph: 952-471-0590 MINNETONKA, M N 55345 Fax: 952-471-0682 1. Property owner information: Name of each property owner:_ 1 QP \kPc, Mailing Address: \ - Iry JC.---I-)61,(_,(L31---re City: OQ.QN.cj State: NN Zip:,WI Email Address: ,h\e. S,n c_gt�f-in I , e`(Y1 Phone:1e) )7 1 2. Contracting company information:iLA � ,� p��J Business Name•1 (i4 Li F Tr I N Representative Name/-( L-A�! ! RJ\ Business Address: L'J State: i-jtt Email Address: In C oc-k-aI\r. L'C`!`r1 Phone:951/L -1)-336 6 Ongoing performance bond with MCWD: B'Yes ❑ No Bond Number: 1&t44,7-7 l5 3. Project Details: Project address: 122+ WI L })IAt City: Oe.UR D State: H County: 1.14\ t N Property ID number (PID): 0-1111 Z51 \/)(y214, Type of Project: ❑Vegetative restoration ❑ Bioengineering e Riprap ❑Retaining wall In-kind replacement: 'es ❑ No Erosion intensity score (if not in-kind replacement): Located on lake: H 11\4 Length of shoreline affected: l 5 (lineal feet) Describe any existing structure along shoreline: SCI:---'(kereG IZ+3C ►q�y I r+o L- Ke Access to project site by: ❑Ice L Barge El Upland corridor) Financial assurance bond acquired: LI Yes ❑No (If not an ongoing performance bond please fill out next page) By signing below, I hereby request a permit to authorize the activities described herein. I certify that I am familiar with MCWD Rules and that the proposed activity will be conducted in compliance with these Rules. I am familiar with the information contained in the application and,to the best of my knowledge and belief,all information is true,complete and accurate. I understand that proceeding with work before all required authorizations are o.tained may be subject to federal,state and/or local administrative,civil and/or criminal penalties. -7/Qi„ Signatti - .`'pr..erty o er or contracting representative Dat Page 1 of 2