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.6:41 MINNEHflHfl CREEK UflTERSHED 6124710682 P.02/02 <br />WATERSHED DISTBIOI <br />OCT 2 6 2000 <br />) <br />COMBINED JOINT.NOTIFICATION APPLICATION *pp, <br />it this fomi 10 nolify/apply to the Minnehaha Cnxk Watershed District- (MCWD), llictr engineering consultants, the <br />DNR, and the Hennepin Conservation District ofa proposed waier/wetland project or work which may fall within their <br />jurisdiction.. These agencies should advise you of their jurisdiction or permit nsquirements within 10 days. Fill out tliis <br />form completely mail a copy, with plan, maps, etc... the MCWD, Gray Freshwater Center, Navarre, 2500 Shadywood <br />Road Suite 37, Excelsior, MN 55331. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED <br />authorizations before beginning work ._____- • ________:_______________ <br />2 Location ofproposed project (Atudt drawing w/directions to site); <br />COUNTY QTR SECTlON($) SECTIONfs) TOWNSHTP(s) <br />i|-| <br />Phone N <br />i/ECT ADDRESS: <br />RANGE(s)Lot, Block. Subdivision <br />3.LENGTH OF SHORE AFFECTED (in feet): <br />AREA FILLED OR EXCAVATED IS <br />VOLUME OF FELL OR EXCAVATION (Cubic yards): <br />, OR XS^OO Square Feet. <br />4.type OF PERMIT BEING APPLIED FOR: (Check all that apply): <br />□STOW-fWATER MANAGEMElfT PLAN Q FT.OODPLAIN ALTERATION <br />□STORM SEWER OUTFALLS <br />□ICE RIDGE REMOVAL <br />□SHORELINE IMPROVEMENT <br />a.QRlPRAP <br />h.QSANDBLANKET <br />c ORETAlNING WALL <br />OrtlER (DESCRIBE) <br />□BRIDGE & CULVERT CROSSINGS <br />JISJWETLAND ALTERATION <br />□EXCAVATION (DREDGING) <br />a.Q WILDLIFE <br />b.^ NAVIGATION <br />c. ^ BIOENGINEERING <br />4a. APPLICANT’S REPRESENTATIVE; (Licensed Contrartor, Engineer, etc...) Include name, address & phone number. <br />5.PROJECT PURPOSE (why is this project needed • wliai benefits will It provide?)&uii)DiM6©rT&/i^..r^vApe)jr pp'.c- <br />6 ALTcRKATtVES (duar.be ay olhrr sUu or melhods lhat could bo usal lo achieve Iho purpose of your projecl while avoldinij <br />or minimizing watcr/weiland impacts. Attach additional sheets, if needed. <br />7 OATES: Proposed start of activity;Proposed c^plclion. <br />(Identify any completed work on attached drawing)*•' >_____________________ <br />8.NAhf^& ADO^SSED OF ADJOINING PROPERTY OWNERS (Attach list if mor?)JAIv ^A. ADORE <br />9.PERMITS HAVE BEEN RECEIVED (R) OR APPLIED FOR (A) FROM: ^DNR <br />_____COUNTY_____CITY .. MN POLLUTION CONTROL AGENCY <br />Army corps of engr <br />I hereby notify the recipients of this fond of ilte project proposed herein and request I be advised of any permits or other ... <br />deteeTTunations concerning this projea that I must obtain. I understand that proceeding with work before all required authoriza>io <br />are obtained may be subject to Federal, State and/or local administrative, civil and/or criminal penalties.