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18 - 2-W7 <br /> LAKE SHORELINE STABILIZATION <br /> PERMIT APPLICATION FORM <br /> MINNEHAHA CREEK WATERSHED DISTRICT(MCWD) <br /> 15320 MINNETONKA BLVD. Ph: 952-471-0590 <br /> MINNETONKA, MN 55345 Fax: 952-471-0682 <br /> 1. Property owner information: <br /> Name of each property owner: Stephen Rudolph <br /> Mailing Address:2480 Casco Pt. Rd. city: Orono state:Mn Zip:55391 <br /> Email Address: Phone:763-464-8057 <br /> 2. Contracting company information: <br /> Business Name:Concept Landscaping Representative Name:Jonathon Smith <br /> Business Address:P.O. Box 430 city:Mound State:Mn Zip:55364 <br /> Email Address:smith3lake@aol.com Phone:612-750-2456 <br /> Ongoing performance bond with MCWD: Yes on file <br /> g g p ❑No Bond Number: <br /> 3. Project Details: <br /> Project address:2480 Casco Pt Rd city: Orono State:Mn Zip:55391 <br /> County:Henn Property ID number(PID):2011723210037 <br /> Type of Project: ❑Vegetative restoration ❑ Bioengineering ❑■ Riprap ❑Retaining wall <br /> In-kind replacement: 0 Yes ❑No Erosion intensity score (if not in-kind replacement): <br /> Located on lake:Minnetonka Length of shoreline affected:140 <br /> g (lineal feet) <br /> Describe any existing structure along shoreline:Rip-rap & boulder Walls <br /> Access to project site by: ❑Ice ❑■ Barge ❑Upland corridor <br /> Financial assurance bond acquired: ❑Yes ❑No (If not an ongoing performance bond please fill out next page) <br /> 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 <br /> the proposed activity will be conducted in compliance with these Rules. I am familiar with the information contained in the application and,to <br /> the best of my knowledge and belief,all information is true,complete and accurate. I understand that proceeding with work before all required <br /> authorizations are obtained may be subject to federal,state and/or local administrative,civil and/or criminal penalties. <br /> 5-8-18 --- __. <br /> "r E CI <br /> Signatur o roperty owner or contracting representative Date - <br /> Page 1 oft MAY 14 2018 <br /> By <br />