Laserfiche WebLink
(feet)- - - <br />/ /d Ji <br />e and correct <br />he <br />(appliccmt) <br />(leasee) <br />91^-0-7-fC -l4 <br />:r.) yy_221 Rev. 74 STATE OF MINNESOTA <br />DEPARTMENT of NATURAL RESOURCES <br />Division of Waters, Soils and Minerals <br />NOTIFICATION OF PERMIT APPLICATION <br />INSTRUCTIONS FOR THE APPLICANT <br />Minnesota Statutes, Section 105.44, Subdivision 1, requires you to supply a complete copy <br />and all supporting data of your water permit application to the following: <br />The chief executive officer of the city or township within which <br />the project is located. .... <br />The secretary of the Board of Managers of the watershed district, <br />if any, within which your project is located or which your project <br />may affect. <br />A) <br />B) <br />You MUST certify having served the complete application on the above in the box on the back <br />side of the application form W-54. <br />IN ADDITION, if your project is NOT locat^ in a city, a complete copy and all supporting <br />data of the*application should be submitted to the Administrator of the Shoreland Manage­ <br />ment Program for the affected county. <br />Complete this form for each notice served on a local government official. <br />SECTION I {TO BE COMPLETED BY APPLICANTS <br />A) Chief executive officer of the (check)^ <br />jlTi city, EJ township of _ _ _ _ _ _ _uy'QilO <br />B) Secretary of the board of managers of the <br />(prznt ov type name) <br />IcL * watershed district. <br />C) Administrator of the shoreland management program of <br />(print or type name) <br />/Aui(e/n\county <br />(print or type name) <br />FROM <br />(print or type nahe and address of applicant) <br />INSTRUCTIONS FOR THE LOCAL GOVERNMENT <br />Date:19 'T?- <br />XlNOi l\Uk^A lUlNO rv^I\ iruj Vjyy ¥ A <br />This report from provides you an opportunity to submit input to the Department of Natural <br />Resources to assist in deciding whether to grant, modify, or deny the requested permit. <br />It is NOT absolutely necessary for local agencies to officially approve or disapprove the <br />project or make any recommendation, although this may be done if desired. It is requested <br />that local agencies indicate the following, as applicable: <br />A. <br />B. <br />The relationship of the proposed project to local plans for the <br />affected water and related land. <br />The relationship of the project to local land use controls including <br />flood plain and/or shoreland regulations. <br />(continued on reverse side) <br />Tmmm. <br />+■ " <br />■rZ <br />■* <br />c. <br />D. <br />E. <br />F. <br />Please complc <br />this page wit <br />needed. <br />SECTION II (t <br />The applicant <br />application on <br />are submitted <br />(Attach additii <br />RETURN TO: <br />DEPARTMENT OF <br />Division of W <br />Regulations U <br />Centennial Bu <br />St. Paul, MN <br />' ••• • ,. :