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I <br />\ <br />. »- <br />CONSTRUCTION DATA (alno ekatoh or drcan^) <br />NA-02622-01 <br />(W-54) <br />(Rev 74) <br />ChimtlUw| <br />Total length (f€4t) ------- <br />length in leke/streaa - - <br />Bottoa width <br />Side slopes (ratio) - - . . . . . <br />Average depth (f€0t)» ------ <br />Gradient (%)• ---- . . . . . . <br />Eaisting rrcposed Altera! i*'n-* alone %h»>rc rr»'po«pil <br />PHtame al»»ng i <br />Distance waierward (fest)- - - - • <br />Thickness of fill material (f^st) <br />Depth of excavation (feet) <br />1. Describe type of excavation equipment to be used, If known: <br />2. Describe location 'include map) and characteristics of spoil disposal site proposed. <br />3. Would maintenance excavation be necessary? (check) £Z7 YES C—/ ^ Explain <br />4. Volume of material to be removed initially (cubic yarda): ^kIck or silt <br />Sand or gravel *lo*^k or stone_ _ _ _ _ _—— <br />ATTACHMENTS SIS.00 filing fee, /S photographs, J[7 other 9i <br />Applicant declares that information submitted herewith and statements made herein are » true and correct <br />representation of the facts, and that the filing of this application and information with the <br />Comissioner of Natural Resources is prima facie evidence of the correctness thereof. <br />COMPLETE APPLICATION SUBMITTED TO: <br />(i)Oroao <br />Hone of city or taieiehip <br />Box 66 CxyeSal By 55121 <br />a treat 4 poet office <br />Miaaeheha Creek <br />fiame of uaterahed Jiatrict <br />(3) Shoreland Management Administrator <br />Heaaepla __________count/ <br />Dated this ^ S day of <br />/ signed <br />{applicant) <br />'leeaee) <br />Mdrtst 650 North Arw Dr. <br />MouadCity <br />State of Minnesota <br />Heaaepla <br />) <br />ss. <br />state Mima. <br />AFFIDAVIT <br />Zip code <br />County of <br />on this day of April 19 8l <br />Phone 472^3085 <br />before me personnel ly appeared ______________ <br />Ce Bex Velah, Jr« <br />who being first duly sworn ana to me knoim to be the person _ _ <br />executed the same asapplication, acknowledge(s) that <br />who executed the foregoing <br />own free act and deed and <br />that the statements, maps, plans, documents, and other supporting data are true and correct according <br />aia best knowledge and belief. <br />jUf.’.'H E- 50’* ' <br />\ ---------------------- <br />County <br />My commission expires P^fce 4 19 84 <br />NW 201981 <br />OF or;OiV5