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.6:41 kinnewhr creek URTERSHED 6124710662 P.02/02 <br />WATEBSH6D DISTBlUl <br />OCT 2 6 ZOOO <br />) <br />is this form lo noUfy/apply to the Minnehaha Creek Watershed District (MCWD), lliclr engineering consul^ts, the <br />DNR, and the Hennepin Conservation District ofa proposed waier/wetland project or work which may fall within their <br />iurisdiction.. Tnese agencies should advise you of their jurisdiction or permit letjuiremcnts within 10 days. Fill out tliis <br />form completely tnail a copy, vri* plan, maps. etc... the MCWD, Gray Freshwater Center, Navaire, 2500 Shadywood <br />Road Suite 37, Excelsior, MN 55331. Keepacopy for your records. YOU MUST OBTAIN ALL REQUIRED <br />autho rizations before beginning work ._____^__; <br />2 Location of preposed preject (Aoadi drawing w/dlrecUons to site): <br />COUNTY QTR SECnONCs) SECTIONts) TOWNSHIPfs) RANGE(s) <br />Phone N <br />JECT ADDRESS:"1 <br />Lot, Block, Subdivision,'xpseb'v pe <br />37 LENGTH OF SHORE AHnSCTEU (In VOLUME OF FILL OR EXCAVATION (Cubic yards): <br />‘: area filled or excavated is Acres, OR \S^CO Square Fed. <br />4.OF PERMIT BEING APPLIED FOR: (Check all that apply): <br />□.STOPvMWATER MANAGEMENT PLAN Q R^OODPLAIN ALTERATION <br />□STORM SEWER OUTFALLS <br />□ICE RIDGE REMOVAL <br />lj;SHORS-:-rNE IMPROVEhiENr <br />a.^FlfAvA? <br />b.QS^' ‘jBLANKET <br />c aRETAlKING wall <br />OrKHR (DESCRIBE)_________ <br />□BRIDGE A CULVERT CROSSINGS <br />^WETLAND ALTERATION <br />□excavation 'DREDGING) <br />a.^ V . .v£ <br />b.(~l i'i.^'. r\'"jAi’?ON <br />€.□ BIOENGINEERING <br />4a APPLICANT’S REPRESENTATlVEi (Licensed Contractor, Engineer, etc...) Include ne. address & phone number. <br />‘t^4ve. <br />6.ALTERNATIVES (describe any olhsr sites or methods that could be used 10 achieve the purpose of your project while avoiding <br />or mir.imtztng w^ter/weiland impacts. Attach additional sheets, if needed. <br />7 OATES: Proposed start of activity;■^posed completion; <br />(Identify any completed work on attached drawini)*•''____Iwing) <br />8.NAMES.& ADDRESSED OF ADJOINING PROPERTY OWNERS (Anach list If mor?) <br />9.PER.MITS HAVE BEEN RECEIVED (R) OR APPLIED FOR (A) FROM: <br />COUNTY_____CITY .. MN POLLUTION CONTROL AGENCY <br />DNR ARMY CORPS OF ENOR <br />I hereby notify the recipients of this fomf of Ute project proposed herein and request I be advised of any permits or other <br />determinations concerning this projea that I must obtain. I understand that proceeding with work before all required authonza t <br />are obtained may be subject lo FoderaL State and/or local admLustrative. civil and/or criminal penalties.