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11/12/01 10:19 FAX 763 377 7089 DUNBAR DEVLPMNT E 005
<br /> Sent Sy: -LOUCKS ASSOCIATES , INC. ; 612 424 5822; Nov-9-01 10:47AM; Page 6/6
<br /> . ..- w &gigs, iP-c r Ill IIINNriHmm ld<ttK WH I hRSHED; 6124710682 P.05/05
<br /> COMBINED JOINT NOTIFICATION FORM-WATER RTI OIJR ,-F TI41: vs'
<br /> Use this form to notify/apply to the Miwnchaha Creek Watershed District (MCWD),their ellialtili aiktantF e
<br /> DNR,and the Hennepin Conservation District of a proposed waetr/wetlend project or work which mme 'tit eir.
<br /> jurisdiction..These agencies should advise you of their jurisdiction or,partoit requi ' in 10 days,Fill ourthis
<br /> form completely mail a copy,with plan.,maps, etc... the MCW'D,'Gray Freshwater Censer, av , 'od
<br /> Road,Suite 37,Excelsior, MN 55331, Keep a copy for your records,YOU MUST OBTAIN ALL REQ U�
<br /> AUTHORIZATIONS BEFORE BEOINNINO WORK,
<br /> 1.Applicant's Name(Last,First,MI) Phone No.
<br /> .Dtilili c . Prep k, ' Chief2Ienaner ..
<br /> Address(Street,RFD,Box of,City.State,Zip)
<br /> " 111 - r . ' " , - / 1 . r i . - . . � , .
<br /> .2. Location of proposed project(Attach drawing W/directions to site);
<br /> couNrf QTR SECTION(s) SECTION(s) TOWNSHIP(o) - RANGE(s) Lot.Block,Subdlvidon '
<br /> Hennepin Cty . NE & SE Quarters of NW Quarter •of Section 34, Township 118,
<br /> Pp.OJECiADDR4SS: Range 23 Butlot F , Sugar t!iogds __�
<br /> 3. LENGTH OF SHORE AFFECT D (in feet): NA . VOLUME OP P: .L OR EXCAVATION(Cubic yards):
<br /> AREA FILLED OR EXCAVATED IS Acres,OR S itt=Feet.
<br /> 4, TYPE OF PERMIT BEING APPLIED FOR: (Check all that apply):
<br /> 12 STORMWATER MANAGEMENT PLAN 0 FL'OODPLATN ALTERATION 0 WETLAND ALTERATION 1
<br /> CISHORELrNE D PROVEME.NC OSWRM SEWER OUTFALLS D EXCAVATION(DREDGING)
<br /> a.ORIPR ' a.0 WILDLIFE
<br /> b J SANDI1LANKBT DICE RIDGE REMOVAL b.❑NAVIGATION
<br /> c.[JRETAINING WALL c.p B/GENGINEERINO
<br /> ©BRIDGE&CULVERTLCROSSTN.GS .
<br /> OMER(DESCRIBE)
<br /> da. APPLICANTREPR SENTATWVE (Licensed Co ctor,Engineer,'cite...) include tare,address&phone number.
<br /> Loucks Associates , Jefftey A_ Sloopek, 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 /> Sen4Ot Housing
<br /> 6.ALTERNATIVES(describe any other sites or metitods.that,mild be sued to aohteve the purpose of your project while avoiding
<br /> OF mlnicniikkg watertwetlaad ianpacts. .Attach additional sheets,if needed ,'
<br /> NA We are alieady avoiding wetland impacts . , •
<br /> 7.DATES: Proposod•stan of activity: r Ptopased cotupleti": February 200 2
<br /> (Idandfy any completed work a a dria%
<br /> $, NAMES&J)DRESSECl OF ADJOIMNa PROPERTY OWNERS(Attach list emote)
<br /> L,
<br /> 9. PER 4rrS HAVE.BL+EN RECEIVED Qt)OR APPLIED POP.(A)FROM:_ _DNR x ,ARMY CORPS OF B 4GR
<br /> COUNTY. Y .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 permits or other
<br /> detenminadonS s onoeming this protect that I must obtain.I undersuuid that proceeding with work before all required authorizations
<br /> are obtain-' - =y be ,i o Federal, State and/or local administrative,civil and/sr criminal penalties.
<br /> /1/44/4 i.
<br /> S' of •erson Proposing Project or Agent. Dam
<br /> TfrTCJ 0 DIC
<br />
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