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FEB-0T-199S 12=^6 MinriEHAHH 'IPEB MhTEPSHED El24710632 P.02 Cf2 <br />SANDBLANKET PERMIT & SAND SOURCE EXHIBIT FORM <br />MINNEHAHA CREEK WATERSHED DISTRICT <br />PERMIT <br />Cas&Y^ <br />Troper^’ Owner <br />re.siding al 3. (0/LO/^O <br />Ad tiro 55 <br />za C S3 <br />City, Sraic» Zip <br />or PID# <br />Count>' Township, Seelion, Ran;;c (from pn.>pci1y tax staiemenl) <br />own and occupy the above single family residence and \visli to install a sandblunkct on <br />— Stu^SS S ____. <br />Lake ^ Bay <br />contracted with 7 ____nt ^.r^ZZji <br />^ contraelor flJdrc*'^ <br />Si OfLj install clean sand from the folic <br />^ cityT^c. zip <br />bJjy>.0 A'e^uA£- rr)A^* <br />supplier address <br />source: <br />supplier Qu-tiiv^ <br />I will install the sandblankel myself from the followang source. <br />phone <br />address phone <br />supplier <br />If this project requires municipal approval or review, please allach documentation of the municipal approval <br />with this application. My shoreline is^C/___ and the dimensions of the proposed .sandblunkct arc; <br />(Length) x /D (Width) x ^ (Depth). Sandblanket dimensions cannot exceed a <br />length of 50’ (or 50% of shoreline), a width of 10 ’ and a depth of G”. <br />I understand that if this application is not completely filled out, or if I fail to submit the required exhibits <br />the application is incomplete and wall be returned. It will not be reviewed by MCWD staff until complete i <br />By signing this application, I agree and understand that the Di.strict may enter the properly at rea.sonabh <br />hours to conduct an inspection to determine whether the term.s ol the permit arc being met t furthe <br />understand tliat if I violate the terms and condition.s of a permit that i.s issued based upon Ihi.s application <br />the District shall conduct a field inspection of the project per MCWP Rule f, provided with thi.s application <br />‘ I understand the District will charge fees to cover the actual costs of field inspections, including investigatioi <br />of the area affected by the work, analysis of the work, including the .sen'ices of legal counsel and engineers <br />and any .subsequent monitoring of the work. The District’s actual costs are deemed to begin accruitig whei <br />the District issues notice of the violation to the permittee. 1 have read and understand the MCWD Technica <br />Guidelines for sandblankets. <br />.‘^.Signature of property ovvncr <br />/MtvA-7 <br />Date <br />Subscribed and sv/orn to before me this day of-/2^CT/ i y <br />* -...- NICCUM *DEC 31 1997 <br />KcNNtPlN COUNiY | <br />My Comm, txpjes Jan. 31. 2000 ^ ^ | ' '* 0 <br />Date <br />5.1iul I • M«l' 'j' <br />TOTAL P.02