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JIJi; Y1--2fln t=00f'1I HHEHHHH =F'EEt WATERSHED ,1''4T1n1zP�= P.02:•02 <br /> 1 : <br /> . ,. iJ"'GLRS! .o•rJb r iNN HHH t U. K WATERSHED61247f P.02/23 <br /> COMBINED JOINT NOTIFICATION FORM- WATER RESOURCE APPLICATION <br /> app( <br /> Use this form to notify/apply to the Minnehaha Creek Watershed District (MCWD), their enGinocring co sultactts, the <br /> DNR, and the Hennepin Conservation District of a proposed water/wetland project Or work which may fall within their <br /> jurisdiction.. These agencies should advise you of their jurisdiction or permit requirements within 10 days. Fill out this <br /> form completely mail a copy.with plan,maps, etc... the MCWD,Gray Freshwater Center, Navarro, 2500 Shadywood <br /> Road, Suite 37, Excelsior, MN 55331. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED <br /> AUTHORIZATIONS BEFORE BEGINNING WORK. <br /> T. Applicatu's None(Lase. First, M.L} Phone No. <br /> aa • - - 612 922-2560 <br /> Address(Sum RFD,Box IF,city,Sate,Zip) <br /> • of - - , : enue Suite 112 , Minneapolis , MN 55436-2333 <br /> 2. Location of proposed project(Attach drawing wldirnRions to Site): <br /> LOt <br /> 19-22 Navarre <br /> CQIN7Y QTR sECTION(s) SECTION(s) TOWNSHIP s) RANGE( Lot, Block. Subdivlsion <br /> f(f`bAdditior <br /> PROJECTADDRESS:23$0 Shadywood Road CR 19 ) Orono, MN 11.1 l l <br /> 3. LENGTH OF SNORE AFFECt D(its fat) VOLUME OFFa L OR EXCAVATION 7 + ar yy v 1:'Ca AREA FILLED OR EXCAVATED IS None (Cubic yards): <br /> Acres, OR Square Fed. <br /> • <br /> 4: TYPE OF PERMIT BEING APPLIED FOR: (Cheek all that apply): - <br /> ® STORMWATER MANAGEMENT PLAN O FLOODPLAIN ALTERATION 0 WETLAND ALTERATION <br /> DSHORFLINE IMPROVEMENT 7W.STORM SEWER OUTFALLS 0 EXCAVATION(DR EDCING) <br /> a.pR1pAAP a.D WILDLIFE <br /> b.OSANDRLANKET LICE RIDGE REMOVAL b.Q NAVIGATION <br /> c.QRETAINTNG WALL c.D BIOENGINEERING <br /> DBRDOE& CULV> T CROSSINGS <br /> OTHER(DESCRIBE) <br /> ta. APPLICANT'S REPRESEATTATIVE:(Lagged Caa6ractor. Engineer,etc...) Include name,address&phone number. <br /> Bob Wiegert -- Paramount Engineering & Design: , 1440PArcadeNSt51N, <br /> 5. PROTECT PURPOSE(why is this project needed-what berets will It provide?) <br /> Construction of a Snyders Drug Store <br /> 6. ALTERNATIVES(describe any other sites or methods that could be used to achieve the purpose of your project while avoiding <br /> or mita miring watedwettaad imincts, Attach&deaden&sheets,If needed. No wetland impacts are proposed . <br /> On-site water quality and stormwater pond is desifned in accordance <br /> . 646 A.a. DATES: Proposed start of activity: Proposed completion. <br /> (Identify any completed work on attached drawing) M I N N E H A FiA CREEK. <br /> 8. NAMES do ADDRESSED OF ADJOI IM PROPERTYWNEO R$(Audi list if more) ' <br /> PGRMTT5 HAV>=BEEN RECEIVED <br /> .11M t 5Dii <br /> (R)OR APPLIED FOR (A) FROM: DNR ARMY CORPS OF ENGR <br /> CS NTY Av <br /> x CITY IAN POLLUTION CONTROL AGENCY <br /> hereby notes the recipients of this fortr(of the project proposed herein and request I be adviS-• o any p:r'"at x or o er" -""" <br /> determinations concerning this project that I must obtain. I understand thatwith work before ail <br /> are ob in may be to F-..eral, State and/or tool proceeding required authorization <br /> � C administrative,.Civil and/or criminal penalties. <br /> Signature of Pelson Proposing ptgJa.:s or Agent Date <br /> TOTAL F.02 <br />