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COMMUNlCATlONSjMED^^M^ <br />ORI6INAI. DOCUMB^ <br />ATTACHtEiTI_____________________________________________________ <br />'• COMBINED JOINT NOnFrOCnOy FOB-M - WATER RESOURCE APFLieATION wi' <br />1. Applicant’s Name (L2^‘First, M.L) <br />aA?<\-S5 y.r^U^^Of/ <br />Phone No.- • - qfcii <br />i. TYF£ OF PERMIT BEING APPLIED FOR: (Check ail that apply): <br />^STORMWATER MANAGEMENT PLAN □ FLOCDPL,\IN ALTERATION <br />□STOPJvI SEWER OUTFALLS <br />□ICE RDGE REMOVAL <br />□SHORELINE IMPROVEMENT <br />a. ^RI?R.AP <br />b. ^SAN'DBLAhTiCET <br />c. n RETAINING ’./ALL <br />□BRIDGE & CULVERT CROSSINGS . <br />□ WETLAND ALTERATION <br />□ EXCAVATION (DREDGING) <br />a. ^ WILDLIFE <br />b. ^ NAVIGATION <br />€•□ BIOENGINEERING <br />OTHEPrtDESCRIBE) <br />4a. APPLICANT’S REPRESENTATIVE: (Licensed Contactor, Engineer, etc...) Include name, address & phone numbo’. . <br />f //yc/C. 1—OT5 <br />PROJECT PURPOSE (why is this project needed - what benefits will it pro\-ide?) ^ . <br />71? £>l-y*0€ /f ^ACT ^STMTf' Lo'/TU 3 //^O At <br />S I/• c <9*^a<,( Ay£UA fycnis <br />5^^ . • .BtfilTh <br />6. ALTERNATIVES (describg.any other sites o'- methods diat could be sued to achi^e the purpose of your project while avoiding <br />'j- '^/Jrk<v^c jf/^Y g;^rL4A^JS.______|_____LL____ <br />7. D.ATE5: Proposed sart of activity; ! SAji'yAJl^ ^7- ’’Proposed completion^ ’'f 7 <br />' ■ (Identify any.completed.work on. j’pacheid. drawing) <br />^ NA.AES <2; ADDRESSED OF ADJOINING PROPERTY OWNERS (Attach list if more) <br />A~TTA<C4A^0 U-gT • • • <br />) PEPwMITS HAVE BEEN RECEIVED (R) OR APPLED FOR (A) FROM:___ <br />_____COLTsTY' • xr^^GITY MN POLLUTION CONTROL AGENCY <br />DNR ARMY CORPS OF ENGR <br />i htrer- rciif/ the redpien*,s of this form of the project proposed herein and request I be advised of any permits cr other <br />dete.-minaucns concerning.vhis project that I must obtain. I unde.”stand that proceeding with work before all requrri authorizaticrs <br />arc ct’^'ined may be subject to Fedeml, State and/or locai admirJstrative, civil and/or criminal penalties. <br />'A-rrb(KN^ 'poc;. \^j\% /‘Ty? <br />Tsasj^'e cf Person PrcccsLng Project or Agent ^ 6d VT_______Date_________________________ <br />•«