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Pro � f WATER RESOURCE PERMIT APPLICATION FORM Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD)of a proposed project or work which may fall within their jurisdiction.Fill out this form completely and submit with your site plan,maps,etc.to the MCWD at: 15320 Minnetonka Blvd.Minnetonka,MN 55345. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. 1.Name of each property owner: GJ Property Management Mailing Address: PO Box 306 City: Maple Plain State: MN Zip: 55359 Email Address: joe@gordon-james.com Phone: 763-479-3117 Fax:763-479-3128 2.Property Owner Representative Information(not required) (licensed contractor, architect,engineer,etc...) Business Name: Gordon James Construction Representative Name: Joe McPherson Business Address: PO Box 306 City: Maple Plain State: MN Zip: 55359 Email Address: joe@gordon-james.com Phone: 763-479-3117 Fax:763-479-3128 3. Project Address: 3445 Watertown Road City: Orono, MN State: MN Zip: 55356 Qtr Section(s): Section(s): 32 Township(s): 118 Range(s): 23 Lot: Block: Subdivision: PID: 32-118-2343-0009 4. Size of project parcel(square feet or acres): 1.4 Acres Area of disturbance(square feet): 4,500 SF Volume of excavation/fill(cubic yards): 250 CUYDS Area of existing impervious surface: N/A Area of proposed impervious surface: N/A Length of shoreline affected(feet): N/A Waterbody(&bay if applicable): N/A 5. Type of permit being applied for(Check all that apply): * EROSION CONTROL ❑ WATERBODY CROSSINGS/STRUCTURES ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANAGEMENT ❑ WETLAND PROTECTION ❑ APPROPRIATIONS ❑ DREDGING ❑ ILLICIT DISCHARGE ❑ SHORELINE/STREAMBANK STABILIZATION 6. Project purpose(Check all that apply): * SINGLE FAMILY HOME ❑ MULTIFAMILY RESIDENTIAL,(apartments) ❑ ROAD CONSTRUCTION ❑ COMMERCIAL or INSTITUTIONAL ❑ UTILITIES ❑ SUBDIVISIONS(include number of lots) ❑ DREDGING ❑ LANDSCAPING(pools,berms,etc.) ❑ SHORELINE/STREAMBANK STABILIZATION ❑ OTHER(DESCRIBE): 7.NPDES/SDS General Stormwater Permit Number(if applicable): N/A 8. Waterbody receiving runoff from site: NONE 9. Project Timeline: Start Date: 2/16/2015 Completion Date: 7/31/2015 Permits have been applied for: City 0 County MN Pollution Control Agency ®DNR ❑COE 0 Permits have been received: City�County—�MN Pollution Control Agency DNR--M COE—Q 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 this 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 obtained may be subject to federal,state and/or local administrative,evil and/or criminal penalties. Signature of ch Property Owner Date Revised 7/15/13 Page 1 of 1