1994 - MCWD app for permit - Laserfiche WebLink

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MINNEHAHA CREEK WATERSHED DISTRICT FOR OFFICE USE ONLY �,�AFIA CA. 14600 Minnetonka Boulevard ..�-F� 11�!F►r^u� e-="r-c hermit Application No. g T -I z/ Minnetonka, MN 55345-13sN\ �=, r"rt i ue Received Notice Sent daleop y'9S_ �' # Agenda Date NED0\..0 �)j,JI_ 1Z:+ APPLICATION FOR PERMIT- FORM A SEE REVERSE SIDE FOR INSTRUCTIONS A +SI D 1. OWNER --_ - - 2. OWNER'S , -1>/, ,L, , j G ,v,e--A/ lt, REPRESENTATIVE: rap a Type 2--6 D5--- 7,rfjr 4;6 Fri Y -7 %2D ( an c i- o.rnA s c- r--,_ , (Address) (City) -- .(Address) --.— eZ3-3�4 7_, /v/ "(47 ?1 S' Ain-t- \-0.,--- 1f)o - , (Telephone) %Z/(r3(� Rip) 3 S 3 3/ .(Telephone) '1 11_ y‘1$ (Zip) c-� 3 es Owner's Signatu • 7- / '-' GG�!/Cr_..' 0 P.E. 0 RLS. 0 Lk 0 OTHER ! // 3. Project Location: 1 - 1 1-7 - 2_3 - 2_1 - 0 0 0 `7 -- City 0.A..0-',---0 County .— 1/4 Sec. Sec. Township Rance 4. Project Address: kci 9 Q��°� ) o SS�:_h�kQ. 5. Permit:Requested For: (Check all appropriate boxes) B. ❑ Stormwater Management Plan C. lY Floodplain Alteration R cu,,.,,,....i, O • Commercial D. ❑ Wetland Alteration ❑ Industrial E. 0 Dredging --❑ Institutionai or F'ghway F. Q' Shoreline/Bank Impro•••t'ment EY- Residential G. ❑ Stream/Lake Crossings NOTE: Applicants Laying Sandblankets Must Use Application For Permit - Form B - 6. Describe the Project: P r\wP d- 1un�a.c..` -.c 5 So-E 1 ..�1 ..a.. 1�.••- I. a :y _1 S-A A . 10 - 2-° D S • ilfthisjprogect requires municipal approval or review, attach documentation of municipal review. J- -..- /tel ) -'...- - ' '3odyrf-water, stream or wetland affected by nmoff_from is-sites--Q0.,.\�4_ Y1'1 -�-<<�- _= -- - Distance from project: 8. Schedule for construction, implementation of temporary-erosion control, substantial completion and restoration: 19SA-f =Please call (612) 939-8320 if assistance in completing this-foe-611S required. In submitting this form,.the app1icaitt`- acknowledges all requirements for permit approval as determined by the published rules dated May, 1991.