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MAR-29-2004 1 11 MINNEHAHA CREEK WATERSHED 6124710682 _P.02//02 <br /> bAN6 <br /> W &� SOURCEFORM Oti.ll <br /> WATERSHED DISTRICT <br /> • troll - <br /> 12---c?cr,fyk <br /> Piapiiti owner residing at-1 a!�. ,Q �'-�-^��� , C'��= � S'S <br /> kith= fib. .ZIP <br /> - LaS8 or MD* 01 - ZI-1 -a3 3i ^003, <br /> Thane Comfy Taisiskip,tidbits,Raw Om prep/sty sac ablesadit <br /> vwn and oopupy the above sinks family zenickain and wish tom WI a asxrdblanket on <br /> YO4 ,-.e,, — SA-arZt LcOr.e_ ( Irn� .�... ,.. <br /> AP <br /> 9i.{i <br /> wee Soy • :3613 PRIEST SANE <br /> B' Lbs ccantr�odwig <br /> LOU:\913, �� s <br /> et <br /> ,mb,a+v toinslai1 clean Bund front the following source: <br /> Yr..., SRAPPlite o4 +draw (Jadlc4 y-`f8 - 41-7 ,or. <br /> I install myself from the following source. <br /> addicts tepee <br /> If this project requires municipal approval or review,please atlaoh documentation of the municipal approval <br /> with this application.My shoreline is 1 1 2-- .feet and the dimensions of the proposed sandbianket arc <br /> -- -°—.. I . i o' . fit') z CP" _ (Depth).Sondblanket dimensions cannot exceed a <br /> length of 50' (or 8096 of sieordisre),a width of 10'and a depth of Er. <br /> I understand that if this t completely filled out,or if I foul to submit the enquired wits, <br /> the application is nsaantp a and will be :warned. it will not be mimed by MCWD staff until complete. <br /> By signing this applioation,I agree and understand that the Dtuiiot rasp crew the ptopeTty at resiecetabk <br /> hours b conduct an inspection b daermise whether dee senate of die permit are being meet. I further <br /> andesstaerdthat if f violate dm terms and conditions'of a permit that is issued basedtis application, <br /> the Dirtsiot dish conduct a fifield inapsetior of the palled per 144CM) ,i, provided with this <br /> I understand the Marla will charge fees to erthe ached af000� field <br /> of the area affected by the wow analysis of the wont, including the services of legal counsel and instructs, <br /> and as of lbs work-The District's actual sods are donned to begin accrauiS when <br /> dee District uncles notice of the vitiation to the perm tee,I have read and understand the MCWD'Technical. <br /> Guidelines for , . . ,, • <br /> .4di & _ f_ <br /> cF) ---/ -6 X <br /> :/ <br /> n <br /> J/)�/)� DateSiductllsed I// <br /> and ni to be hne me Ow' day of, •/\_1 // /ag <br /> kf - NANCY L.RODGERS WIitj,q ,l u �, Mycombsa,Ex$m5Jen.312005 <br /> Notary ' <br /> *awed and Jh.�-, r• / 1. r-'.e M g ' . I 9 <br /> tames}Iafi er_ Maim*T ,,,, .,. 1 U . <br /> MAR 1'1 2004 <br /> . <br /> TnTni o ran <br />