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CKO ENTERPRISES INC. 17-2/910 139 <br /> lo <br /> 1844 W WAYZATA BLVD. <br /> LONG LAKE, MN 55356-9491 <br /> DATE <br /> PA <br /> ORDER OF $/ oject or work which may fall within <br /> etc.to the MCWD at: <br /> DOLLARS <br /> , <br /> 3EGINNING WORK <br /> g bank. — <br /> kcom�O . <br /> � � _State: mn Zip: 55356 <br /> 1:09 &0000221: 104 ? ? 31361911'0139 Fax. <br /> trchitect, engineer, etc...) <br /> tsusmess lvamc: �.,���„ � ,_ Haack <br /> Business Address: PO Box 306 City: Maple Plain MN 55356 <br /> t2/ State: Zip: <br /> Email Address: will@gordon-james.com Phone: 763-479-3117 pax: <br /> 3.Project Address: 3195 Watertown Rd City: orono <br /> State: MN Zip: 55356 Qtr Section(s): Section(s): Township(s): Range(s): <br /> Lot: Block: Subdivision: PID: 041172322003 <br /> 4. Size of project parcel (square feet or acres): .98 Acres <br /> Area of disturbance(square feet): 8000 sf Volume of excavation/fill(cubic yards):0 <br /> Area of existing impervious surface: 1300 Area of proposed impervious sin-face: 500 <br /> Length of shoreline affected(feet): 0 Waterbody(&bay if applicable): 0 <br /> 5. Type of permit being applied for(Check all that apply): <br /> O EROSION CONTROL ❑ WATERBODY CROSSINGS/STRUCTURES <br /> ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANAGEMENT <br /> ❑ WETLAND PROTECTION ❑ APPROPRIATIONS <br /> ❑ DREDGING ❑ ILLICIT DISCHARGE <br /> ❑ SHORELINE/STREAMBANK STABILIZATION <br /> 6. Project purpose(Check all that apply): <br /> 3 SINGLE FAMILY HOME ❑ MULTI FAMILY RESIDENTIAL(apartments) <br /> ❑ ROAD CONSTRUCTION ❑ COMMERCIAL or INSTITUTIONAL <br /> ❑ UTILITIES ❑ SUBDIVISIONS(include number of lots) <br /> ❑ DREDGING ❑ LANDSCAPING(pools,berms,etc.) <br /> ❑ SHORELINE/STREAMBANK STABILIZATION 3 OTHER(DESCRIBE): <br /> 7.NPDES/SDS General Stoimwater Permit Number(if applicable): <br /> 8.Waterbody receiving runofffiom site: <br /> 9.Project Timeline: Start Date.: August 1 Completion Date:August 30 <br /> Permits have been applied for. City County MN Pollution Control Agency El DNR 13 COE rl <br /> Permits have been received: City—�County— MN Pollution Control Agency— DNR--M COE—n <br /> By signing below,I hereby request a permit to authorize the activities described herein.I certify that I am familiar with MCWD <br /> Rules and that the proposed activity will be conducted in compliance with these Rules.I am familiar with the information <br /> contained in flus ap on and,to the best of my knowledge and belief,all information is true,complete and accurate. I <br /> understand that ce g w" wok before all/ilquired authorizations are obtained may be subject to federal,state and/or local <br /> administrative civ' d/or penalties. <br /> Signa e o Each roperty O er Date <br /> Revised 7/15/13 Page 1 of 1. <br />