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NA-02670-01 <br />(W-221)‘ <br />(Rev 74)STATE OF MINNESOTA <br />DEPAR1HENT of NATURAL RESOURCES <br />NOTIFICATION OF PERMIT APPLICATION <br />INSTRUCTIONS FOR THE APPLICANT <br />Minnesota Statutes, Section IOS.44, Subdivision 1, requires you •* supply a complete copy <br />and all supporting data of your water permit application to the following: <br />A) The chief executive officer of the city or township within which <br />the project is located. <br />B) The secretary of the Board of Managers of the watershed district, <br />if any, within which your project is located or which your project <br />may affect. <br />You MUST certify having served the complete application on the above in the box on the back <br />side of the application form W-S4. <br />IN ADDITION, if your project is NOT located in a city, a complete copy and all supporting <br />data of the application should be submitted to the Administrator of the Shoreland Manage­ <br />ment Program for the affected county. <br />Complete this form for each notice served on a local government official. <br />SECTION 1 (TO BE COMPLETED BY APPLICAST) <br />TO: A) Chief executive officer of the (ohadk) <br />Q city, CD township of OrOMO <br />(print or type none) <br />B) Secretary of the board of managers of theMlmmehmhm Creek watershed district. <br />(print or type none) <br />C) Administrator of the shoreland management program of Heyteplm <br />nr* :(print or type name) <br />county. <br />I <br />FROM: Thoama H. Rudd 1325 Shoreline Dr, Wmygmt* <br />(print OP type nam and addreea of applioant) <br />Date: May S. 1381 <br />l.NSTRUCTIONS FOR THE LOCAL GOVERNMENT <br />This report from provides you an opportunity to submit input to the Department of Natural <br />Resources to assist in deciding whether to grant, modify, or deny the requested permit. <br />It is NOT absolutely necessary for local agencies to officially approve or disapprove the <br />project or make any recommendation, although this may be done if desired. It is requested <br />that local agencies indicate the following, as applicable: <br />A. <br />B. <br />The relationship of the proposed project to local plans for the <br />affected water and related land. <br />The relati onship of the project to local land use MnU'ilt inrludin^ - <br />flood plain and/or shoreland regulations. > ^ ^ f] v//! f j' • , <br />(oontinusd on revwB* aida).N 41981