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' �EP 14 201� <br /> Permit# l� - �-�� <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 /> �,Ccaaa Lo�sa.n reside at_36`W �,�a�a� (Z.�.JQ, , dy��,o <br /> ( erty Owner) ( ddress) (Cfty) <br /> �1 SS35to , blZ ?19•`��177 request approval to install a sandblanket on property described <br /> as �State,Zip) (Phon <br /> 51 O s�0l4 a. , located in fl�f'O�A tn <br /> treet address (WRhin the Ciry boundaries) (County) <br /> D5•11'1,23.. 13 •oslbn , �b1aS <br /> (Property ID#[PID#J) (Lake) (Bay) <br /> I have contracted with � �� , <br /> (Name of Company) (Street address) <br /> , ( ) to install clean sand from the <br /> (Cily,State,Zip) (Phone) <br /> following source , <br /> (Supplier) (Address) (City,Zip) <br /> �� <br /> (Phone) <br /> I will install the sandblanket from the following source_�,�_.S , <br /> 3�1� <br /> �i`i`r���vt � � Uw�d`VI�i� � (S�'pp��(�o(Z� �DSr�1 3� <br /> (Address) �—� (City,State,Zip) (Phone) * <br /> I�� � <br /> My shoreline is 13S feet and the dimensions of the proposed sandblanket are: � � <br /> /'`t "`8—10� y�/GL-{GVUVWt�j( pF D!�(�1/� (Length) "'� <br /> (Q X � . Sandblanket dimensions cannot exceed a length of 50' (or 50%of shoreline), `� �'� <br /> ��Pth� ��h� � � �-� <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 retumed. 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 e Y ation to permittee, I have read and understand the MCWD Technical Guidelines for � <br /> sandblanket . 9�l��,� I <br /> (Sig e of Property O (Date) <br /> Subscribed and sworn to before me on this day of , 20 <br /> Notary Public <br /> Approved by: Date <br />