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RECEIVES <br /> APP 01 2016 <br /> WATER RESOURCE PERMIT APPLICATION FORM UW 0F UKUNU <br /> Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD)of a proposed project or work which may fall within <br /> their jurisdiction.Fill out this form completely and submit with your site plan,maps,etc.to the MCWD at: <br /> 15320 Minnetonka Blvd.Minnetonka,MN 55345. <br /> Keep a copy for your records. <br /> YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. <br /> 1.Name of each property owner: Lyndsey&Justin Aul <br /> Mailing Address: 5791 Sunnybrook La City: Minnetrista State: MN Zip: 55364 <br /> Email Address: justin.aul@oracle.com Phone: Fax: <br /> 2. Property Owner Representative Information(not required)(licensed contractor, architect, engineer,etc...) <br /> Business Name: Gordon James Construction Representative Name: Will Haack <br /> Business Address: PO Box 306 City: Maple Plain State: MN Zip: 55359 <br /> Email Address: will@gordon-james.com Phone: 763-479-3117 Fax: <br /> 3. Project Address: 3465 Watertown Road City: Orono <br /> State: MN Zip: 55391 Qtr Section(s): Section(s): Township(s): Range(s): <br /> Lot: Block: Subdivision: PID: <br /> 4. Size of project parcel (square feet or acres): 60710 sf <br /> Area of disturbance(square feet): 3615 sq ft Volume of excavation/fill (cubic yards):1316 <br /> Area of existing impervious surface: Area of proposed impervious surface: <br /> Length of shoreline affected(feet): Waterbody(&bay if applicable): <br /> 5. Type of permit being applied for(Check all that apply): <br /> VEROSION CONTROL ❑ WATERBODY CROSSINGS/STRUCTURES <br /> ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANAGEMENT <br /> ❑ WETLAND PROTECTION ❑ APPROPRIATIONS <br /> ❑ DREDGING ❑ ILLICIT DISCHARGE <br /> ❑ SHORELINE/STREAMBANK STABILIZATION <br /> 6. Project purpose(Check all that apply): <br /> Z SINGLE FAMILY HOME ❑ MULTIFAMILY RESIDENTIAL(apartments) <br /> ❑ ROAD CONSTRUCTION ❑ COMMERCIAL or INSTITUTIONAL <br /> ❑ UTILITIES ❑ SUBDIVISIONS(include number of lots) <br /> ❑ DREDGING ❑ LANDSCAPING(pools,berms,etc.) <br /> ❑ SHORELINE/STREAMBANK STABILIZATION ❑ OTHER(DESCRIBE): <br /> 7.NPDES/SDS General Stormwater Permit Number(if applicable): <br /> 8. Waterbody receiving runoff from site: <br /> 9. Project Timeline: Start Date: May 15 2016 Completion Date:December 2016 <br /> Permits have been applied for: City El County 13 MN Pollution Control Agency DNR 0 COE 13 <br /> Permits have been received: City El County 0 MN Pollution Control Agency___p DNR 13 COE 0 <br /> By signing below,I hereby request a permit to authorize the activities described herein.I certify that I am familiar with MCWD <br /> Rules and that the proposed activity will be conducted in compliance with these Rules.I am familiar with the information <br /> contained in this application and,to the best of my knowledge and belief,all information is true,complete and accurate. I <br /> understand that proceeding with work before all required authorizations are obtained may be subject to federal,state and/or local <br /> administrative,civil and/or criminal penalties. <br /> Qumoii 1441 4.1.16 <br /> SignaWe of Each Property Owner Date <br /> Revised 7/15/13 Page 1 of l <br />