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m ■V <br />s <br />xiy <br />MIIUIUEHAHA CREEK <br />WATERSHED DISTRICT <br />P.O. Box 387, Wayxala. Minnosota 55391 <br />PERMIT NUMBER <br />DATE RECEIVED <br />AGENDA DATE <br />APPUCABLE REGULATIONS <br />4 <br />See revoTM skto for Inotructlons Do not write above this line <br />1. OWNER; 1? <br />‘ t • • <br />2. APPLICANT: <br />ADDRESS: .^06 ___. ADDRESS: **-*9 <br />CITY: Uigg. Law- zIP: CITY: ' <br />PHONE;------------------------------- SIGNATURE: Oa>X <br />PHONE* <br />3.0 Preliminary plat review <br />E5 Grading/Dralnage Plan <br />□ Bridge, culvert, or utilities <br />□ Rood Plain Deveiopment <br />□ Use and appropriation of <br />Public Waters <br />□ Shoreline Improvement or Rip-Rap <br />□ ShoreUne Setback Variance for <br />Property Improvement <br />□ Rll or excavation <br />□ Permit Extension <br />□ Other ____________________ <br />Describe work and objectives:__1 KA <» ^ g. 1 <br />• e <br />----S ITfc Si_____L^n* <br />4. Project location: — <br />|1o<i.tu ftg_____T.vt ti» <br />\Un.J__TiR i <br />6. Current status with other applicable agencies: KVPLtct».-r. Fii_6.T-> t<s <br />C.\TV ‘ _______;_______________________ <br />E Body of water affected: -XaVc. U) UJi)£roj/kA <br />Call 473-4224 for assistance in completing this form.