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NCV-05-2001 16 30 MINNEHAHA CREEK WATERSHED 6124710682 P.05/005'�(Q <br /> t(" Y L <br /> COMBINED JOINT NOTIFICATION FORM-WATER RESOUR(P '�s7 ai�pi <br /> 1'1 . <br /> Use this form to notify/apply to the Minnehaha Creek Watershed District (MCWD), their en rig gEsultants e <br /> DNR, and the Hennepin Conservation District of a proposed water/wetland project or work which may f 1Os'ith ear <br /> jurisdiction.. These agencies should advise you of their jurisdiction or permit require'. • .: 'in 10 days. Fill out this <br /> form completely mail a copy, with plan, maps, etc... the MCWD,`-Gray Freshwater Center,Nava od <br /> Road, Suite 37, Excelsior, MN 55331. Keep a copy for your records.YOU MUST OBTAIN ALL REQ <br /> AUTHORIZATIONS BEFORE BEGINNING WORK. <br /> 1.Applicant's Name(Last, First, M.I-) Phone No. <br /> Dunbar. , Frank , Chief Manager <br /> Address(Street,RFD, Box#, City, State,Zip) <br /> 53000 Glenwood Avenue Suite. 2.D CL, Mi oJ,Js , MN 55422 <br /> 2. Location of proposed project(Attach drawing w/directions to site): <br /> COUNTY QTR SECTION(s) SECTION(s) TOWNSFHP(s) RANGE(s) Lot,Block, Subdivision • <br /> Hennepin Cty . NE & SE Quarters of NW Quarter of Section 34, Township 118 , <br /> PROJECTADDRESS: Range 23 0utlot F , Sugar Woods <br /> 3. LENGTH OF SHORE AFFECTED (in feet): NA . VOLUME OF FILL OR EXCAVATION(Cubic yards): <br /> AREA FILLED OR EXCAVATED IS Acres, OR Square Feet. <br /> 4. TYPE OF PERMIT BEING APPLIED FOR: (Check all that apply); <br /> [� STORMWATER MANAGEMENT PLAN ❑ FLOODPLAIN AL'1:hKATION ❑ WETLAND ALTERATION <br /> ❑SHORELINE IMPROVEMENT DSTORM SEWER OUTFALLS ❑ EXCAVATION(DREDGING) <br /> a.❑RIPRAP a_El WILDLIFE <br /> b.❑SANDBLANKET DICE RIDGE REMOVAL b.❑ NAVIGATION <br /> c.❑RETAINING WALL c.❑BIOENGINEERING <br /> ❑BRIDGE&CULVERT CROSSINGS <br /> OTHER(DESCRIBE) <br /> 4a. APPLICANT'S REPRESENTATIVE: (Licensed Contractor,Engineer, etc...) Include name, address&phone number. <br /> Loucks Associates , Jeffrey A . Sbopek, P .E . <br /> 7200 Hemlock Lane , Suite 300 , Maple Grove , MN 55369 <br /> 5. PROJECT PURPOSE (why is this project needed-what benefits will it provide?) <br /> Senior Housing <br /> 6. ALTERNATIVES (describe any other sites or methods that could be sued to achieve the purpose of your project while avoiding <br /> or minimizing water/wetland impacts. Attach additional sheets,if needed_ <br /> NA -- We are already avoiding wetland impacts . <br /> 7.DATES: Proposed start of activity: October 2001Proposed completion: February 2002 <br /> (Identify any completed work on attacneodrawing) <br /> 8. NAMES & ADDRESSED OF ADJOINING PROPERTY OWNERS (Attach list if more) <br /> 9. PERMITS HA VE.BEEN RECEIVED (R) OR APPLIED FOR(A)FROM: x DNR x ARMY CORPS OF ENGR <br /> COUNTY g CITY MN POLLUTION CONTROL AGENCY <br /> I hereby notify the recipients of this form of the project proposed herein and request I be advised of any permit's or other <br /> determinations concerning this project that I must obtain. I understand that proceeding with work before all required authorizations <br /> are obtain e . y be ej, o Federal, State and/or local administrative, civil and/or criminal penalties. <br /> ..�� 0 /• <br /> • <br /> Si;bat f of 'erson Proposing Project or Agent Date <br /> TOTAL P.05 <br />