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H-S4 <br />attach sketch or dnrHng) <br />ions along shore Proposed <br />e along shore (feet)1200 Ft. <br />e watcrvard (feet) <br />ss of fill material (feet). . .3 Ft. <br />>f excavation (feet) <br />Dader <br />posal site proposed: <br />/—7 KO Explain: <br />or silt <br />See attached description £ naps <br />r.adc herein arc a true and correct <br />id information with the <br />:tness thereof. <br />27th day of January <br />itrict tngineer (apptiesKt) <br />Ieoin County Park Reserve Pistrict <br />(lessee) <br />296 <br />le Plain <br />Zip code 55359 <br />Phone I*73”^593 <br />e pc.’sonnally -.ppeared Ayr <br />vho executed the foregoing <br />own free act and deed and <br />a are true and correct according <br />^i^AA^JjUAMUUJUULjUUUULU <br />.’-221 <br />lev. 74 STATE OF MINNESOTA <br />DEPARBENT of NATURAL RESOURCES <br />Division of Waters, Soils and Minerals <br />NOTIFICATION OF PERMIT APPLICATION <br />INSTRUCTIONS FOR THE APPLICANT <br />= ms.- "" <br />A) The chief executive officer of the city or to>mshlp within which <br />may affect. <br />you ™ST certify having nerved the complete application on the above in the box on the bach <br />side of^the application form W-S4. <br />Lro"re%ppirc«irn°iroiid%e"uta!ft:d io tb^^ <br />ment Program for the affected county. <br />couplet, this fora, for each notice served on a local governuent official <br />♦ . * * ** * * ** * * ** * * * ** * * * ♦* * * ** * * * • <br />SECTION I (TO BE COUPLETED BY APPLICANT) <br />TO: A) Chief execuUve otflcer of the feheeW <br />/57 city, CJ tovmship of__________lUiai(print or type name) <br />B, secretary of the beard of managers of the <br />watershed district. <br />(■print or type name) <br />C) Administrator of the shore land management program of_ <br />county. <br />(print or type name) <br />Maple PlainTicnothy I. Harr <br />District Engineer - 55359 Date:r-"“...........-r'" tovnty ’’^tk Reserve P tt box 296.H bbp._ <br />Sprint or type name and address oj <br />January TJ t 19 78 <br />...........................................................................................................................*..............................................................................* * * <br />instructions FOR THE LOCAL GOVER.NMENX <br />This report from provides y^ an den^the Requested permit. <br />Resources to assist in , , agencies to officially approve or disapprove the <br />'^neror1:^e“-^-“::M«lo;. It is re,uested <br />Cr^ocS eSncKs indicate the following, es applrcav,.-. <br />A The relationship of the proposed project -.r-ai plans for <br />b’ ?^ffemrorsMroF"ir l-al land use controls including <br />flood plain and/or shoreland regulations. <br />(continued on reverse side) <br />VumV V