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i <br />■^iS'uN'k' <br />MHWCysC'JAHA CREEK ' <br />' ceSTRICT <br />P.o. Box 3?.7, \Va>za!a, riinncr.ota 55391 <br />» A <br />ful'fc-''-;<v- ; ’ 7w »'./ s ‘ ‘Vo <br />'•» . <br />*•• <br />;;< !■.'Mf,. ••;•■ <i iii ' V <br />»• <br />PERMIT NUMBER <br /># • I I . <br />*• . X.-- <br />I ,• IDATE RECEIVED o'v <br />AGENDA DATE ‘ <br />APPLICABLE REGULATIONS • <br />. * • •• • • • <br />\ i«* /* ^ <br />• r. <br />I <br />See rovorse side for Instructions Do not write above this lino <br />t. OWNER: Welsh ..I <br />AODR''S'j’ Hi'.rrt -■x'• <br />CITY:T*^’^.?t____________ZIP: <br />2. APPLICANT: Uli^iAfjS^rik'g^rta ble.., Dreclging <br />ADDRESS:-------------- <br />CITY:PHONE:474-9454 <br />PIIOM5: 47 2—j0>->3 SIGNATURE: <br />3. □ Pr''!ir>irnry plat review ra Shoreline Improv' nont or Rip-Rap <br />□ Grc't -.j/Pr:.’rn^o Plan • ' '. » • * •□ Ghorciine Sc'ba Variance for <br />□ Dri'’'’'', cvl'. e't, er''*.i!!tiC3 •/ *% • • •Property Inp ’;mer.t <br />□ F ced r;:.:n Dr/ri'eTcnt <br />□ Ure pr*d'’r7rop.' '*:cn of <br />1 <br />9 • <br />n Fi!i or e.'ccev'cVr <br />□ PefTnit Exti.ic' <br />D Other j.docic <br />f’ <br />Describe 'v^rit end cb)ectlvc3: - ofat.ni,n __en pugh _ <br />j>va-tc r- de T'*. n. ,Cor_ T!ee<.jilojvi_235._0.jL_9.C------- <br />-chore 1 ire —to—7?rohec*’■ nr^riinnh erecxcLii-,rtiid-J?^utjL''Jf.2L-JLTl»—PuiX^—^~Pj-.05 <br />-doch -ho -r.oc r-'i-b'oxt—,------------------------------------------------------------------------------ <br />f ' ; <br />, „ . . , ■ .. Lot 1 See. 6 Auditorc cuh. Ilo 262 4. Project Iccation: ----------------------------------------- <br />5. Current status with other cppHcab'e egcncies: ?— <br />•»a * f * . , ». X <br />I ‘ '.^1 f*. ■..■■ ; . * .1'.! '. :j ■ V <br />«, Body ot *«v aitoetod' i.'ortl ^ : I,.lc._WVTno to .ja . i <br />1 •..t <br />Call 473-4224 for anislanco In completing Jhls form.-, * ’ji -»n, **»* • #i|t‘ V. *. <br />'.r • *jf. I • • ^ <br />t. <br />% > <br />1 <br />n <br />5 <br />•wr 201961 <br />''TY'unHiTTiTi <br />H * <br />9 <br />«* I <br />. « <br />1, <br />A <br />Hi <br />. 1 <br />■ I <br />"j <br />i