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JUN-19-2006 14 58 M C u D 952 471 0682 P.02/83 <br /> Permit# % - ?2- <br /> Sandblanket Permit and Sand Source Exhibit Form <br /> FAST TRACK PERMIT <br /> MINNEHAHA CREEK WATERSHED DISTRICT (MCWD) <br /> 18202 MINNETONKA BLVD. Ph: 952-471-0590 <br /> DEEPHAVEN, MN 55391 Fax: 952-471.0682 <br /> I, WILL , A1Lav& reside at I %%O f-1°,JrA ( iO <br /> ,, {,Property Owner) ,y (Address) (City) <br /> 1��1V <br /> (Oa) 103- !o 3 request approval to install a sandblanket on property described <br /> (State,Zi ) (P one , <br /> as PQM(') 1 GN uuw k_, located in O!'GNU , Waive.Pp) <br /> (Street A ,� ( the City boundaries) (County) <br /> d2-1n�3 l3-ool� on i'Vl1N/VG�7.'11'J , �(i�JE tL <br /> (Property ID#[PID#]) (Lake) (Bay) <br /> I have contracted with Docrt E/ 7. , / -0 5 „z.a.l,';:, O,', <br /> (Name of Company) (Street address) <br /> 5�1, y P ,k <br /> ,, , A441 SS3' " (y5 4'71— t534/3 to install clean sand from the <br /> (City,State,Zip iPnon <br /> following source WHO I vl-e.I �( '� 604 Le, e 14' rte.n 11,011 <br /> (Supplier) ddress) (City,ZiloY <br /> (9d) ) ' 1N-- <br /> (Phone) <br /> I will install the sandblanket from the following source <br /> (Supplier) <br /> (Address) y� (City,State,Zip) (Phone) <br /> My shoreline is /'5D feet and the dlimensions of the proposed sandblanket are: `ba. X <br /> • �( /Q/ (Length) <br /> (o X _ Sandblanket dimensions cannot exceed a length of 50' (or 50% of shoreline), <br /> (Depth) (Width) <br /> a width of 10' and a depth of 6". If this project requires municipal approval or review, please attach <br /> documentation of the municipal approval with this application. <br /> I understand that if this application is not completely filled out, or if I fail to submit the required exhibits, the <br /> application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. By <br /> signing this application, I agree and understand that the District may enter the property at reasonable hours <br /> to conduct an inspection to determine whether the terms of the permit are being met. I further understand that <br /> if I violate the terms and conditions of the permit that is issued based upon this application, the District shall <br /> conduct a field inspection of the project per MCWD Rule J, provided with this application. I understand the <br /> District will charge fees to cover the actual costs of field inspections, including investigation of the area <br /> affected by the work, analysis of the work, including the services of legal counsel and engineers, and any <br /> subsequent monitoring of the work. The District's actual costs are deemed to begin accruing when the District <br /> issues notice of the violation to permittee. I have read and understand the MCWD Technical Guidelines for <br /> sandbink t <br /> ( igna ure of Property Owner) (Dale) jr� ��-a `� j 1 <br /> Subscribed and sworn to before me on this if t� day of 41-rOY).t6LAj , 20' ( �Ga L -� ioAfrillAii <br /> ti ,_.110.11. SHERYL A. LATTERNER <br /> t <br /> Notary 1 r: :w' <br /> rY Publi �► <br /> NOTARY PUBLIC-MINNESOTA <br /> My Commission expires Jan.31.2010 <br /> Approved by: Air/ f "`'�� Date <br />