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FEB-20-2009 15�16 P.02i02 <br /> Permit # (.:�.�- d 3� <br /> Sandbfanket Permjt and Sand Source Exhibit Form � <br /> FAST TRACK.PERMIT <br /> MINNEHAHA CREEK WATERSH�D DISTRICT (MCWD) � � <br /> 18202 MINNETONKA BLVI?. Ph: 952-471-059C1 <br /> DEEPHAVEN, MN 55391 F�x: 952-471-0682 <br /> , I � ,�� ) a � � ' � � � ; __.��rar� o <br /> I, 1!�1 f I l 1 YI!\ reside at <br /> (Property Owner) (Address (C��Y) <br /> '��? h , (_) � request approval to install a sandblanket on property described <br /> (State.Zlp) (Phane) • , <br /> as , located in � , <br /> (Strcet address) (wlthln Ihe Ch,y boundarie9) (Caunty) <br /> ��3�-�� "�A�I�� <br /> ���-ll�- ,� o .s' on � , / add�es5 <br /> (Property ID It�PID#]) (Lake) (Bay) �b <br /> ❑I have contracted with se ��r ��_�� N'� , _r� �l� �)G-J 1 e�� ��Ew'-��f <br /> �Name of Compsny) (SUeel addr es) <br /> �f Q y� �� v, s 5'�y�� , ('j¢�)�7f1�/S yC� __to install clean sand from the <br /> (Clty State.Zip) (Pho�e) , <br /> following source S h a l�o n c � �r�u� ( - � - - � �' <br /> (S pplier) - (Address) (G�Y��P) <br /> � � � �� � � � <br /> (Phone) ��7 �� <br /> -►r <br /> ❑ I will install the sandblanket from the following source �.�� Ra�( � d , <br /> (Supplier) <br /> -� . � �� , .� y S s�7 , c�) yo.3 - y 9� 6 <br /> (Address) ' (cily,Sla e.7Jp) lPhone) <br /> My shoreline is IS'U feet and the dlmensions of the proposed sandblanket a�e_ �� X <br /> � (Length) <br /> ,�^X�. Sandblanket dimenslons cannot exceed a length of 50' (or 50°�of shoreline), <br /> (Deptl�) (Wldth) <br /> a width of 10' and a •depth of 6". If this project requires municipal approval or review, please attach <br /> documentation of the municipal approval with this application. <br /> ! understand that if this application is not completely filled out, or if I f�il to submit the required exhibits, the <br /> appllcation is incomplete and will be returned_ lt will not be reviewed by MCWD staff until complete. 6y <br /> signing this application, I ag�ee and.understand that,the District may enter the property at reasonable hours <br /> t�conduct an fnspection to determine whether the terms of the permit a�e being met. I fu�ther understand that <br /> if I violate the terms and conditions of the permit that is issued based upon this application, the District shall <br /> conduct a field inspection.nf the project per MCWD Rule J, provided with this application. I understand the <br /> Distr(ct will charge fees to cove.r tho actual costs of field inspections, including investigation of tha a�ea <br /> affected by the work, analysis of the work, including the servlces of legal counsel and engineers, and any <br /> subsequent monitoring of the work: The Distrlct's actual costs are deemed to begin accruing when the District <br /> issues notice of the violation to permittse. I have read and understanc� the MCWD Technical Guidelines for <br /> ,. S bla�s , � � �� r � !/�� � � <br /> � �� �C��� <br /> (Signature of Property Owner) � �� (Date) <br /> Subscribed and sworn to beforr�me on this � � day of � 2� <br /> � � o � C� � � d � <br /> Notary Public � �EQ 2 � ?QQ9 <br /> Appraved by: � -� �� � ��`.'_. Date �� � � 1 <br /> TnTcai P c�� <br />