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OCT-11-1999 10: f l I NtIEHHHA CREEK I.J iTEF°SHEL: r 1 4 r 1�=�r F'.�=�5i 05 <br /> SANDI3LANKET PERMIT & SAND SOURCE EXHIBIT FORM <br /> MINNEHAI--IA CREEK WATERSHED DISTRICT <br /> PERMIT 97 — 2-2-Y <br /> ' MJ LST> .SS esiding at x,31 /? at.)fi4e 'Froperty Owner Address <br /> ��J}I <br /> City,State,Zip <br /> or Ptf# <br /> Phone County Township,Section,Range (from property tax statement) <br /> own and occupy the above single family residence and wish to install a sandblanket on <br /> a 271 .,41.jer IL A j <br /> Lake&say. <br /> l'J [ have contracted with MINNET�;i; P,ORTA8LE at <br /> contra*-! lCCU A address <br /> 500W LAKE ST to install clean sand from the following source: <br /> city,state,zip <br /> 474-9454 <br /> supsQs►sr_�� _ Lldr,. �... , Q J <br /> ILI�S� or: <br /> : <br /> address phone <br /> ED I will install the sandblanket myself from the following source. <br /> supplier <br /> address phone <br /> If this project requires municipal approval or review, please attach documentation of the municipal approval <br /> with this application. My shoreline is I-5-3 feet and the dimensions of the proposed sandblanket are; <br /> 54 (Length) x lo (Width) x (Depth). Sandblanket dimensions cannot exceed a <br /> length of 50' (or 50% of shoreline), a width of 10'and a depth of 6". <br /> I understand that if this application is not completely filled out, or if I fail to submit the required exhibits, <br /> the application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete, <br /> Ry signing this application, I agree and understand that the District may enter the property at reasonable <br /> hours to conduct an inspection to determine whether the terms of the permit are being met. I further <br /> understand that if I violate the terms and conditions of a permit that is issued based upon this application, <br /> the District shall conduct a field inspection of the project per MCWD Rule J, provided with this application. <br /> I understand. the District will charge fees to cover the actual costs of field inspections, including investigation <br /> of the area affected by the work, analysis of the work, including the services of legal counsel and engineers, <br /> and any subsequent monitoring of the work. The District's actual costs are deemed to begin accruing when <br /> the District issues notice of the violation to the permit-tee. I have read and understand the MCWD Technical <br /> Gu'delines for sandblankets_ <br /> Date <br /> 'scribed and sworn to before me this _ day of (2. 19 2 ,- 1�M�`~,•~r,~••U4i'..'•„�..M'” <br /> JUDITHHE. NiCCUM � <br /> ABY PUBLIC-MINNESOTA � <br /> HENNEPIN COUNTY <br /> .41/4_7 / �.� Y l omr1. Expires Jan, 31, 2000 <br /> irtary Public <br /> • 40' <br /> Ap r• ed and ;ce ted by l --T--- <br /> ja Hafner, District Technician Date <br /> se�siif •Mar'J7 <br /> TOTAL P.05 <br />