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I'A <br />n3 in^-^ moo <br />fi^dO <br />6 <br />n <br />(jcp <br />l^i^uCO, <br />Lo 52 ^^6)n <br />\^lq l^OOQ! <br />^o^ <br />\ <br />f-i <br />V.; <br />W-221 <br />Rev. 74 <br />;; i <br />*- <br />1^'s <br />#■ ! <br /><1 <br />& <br />r«4; <br />> <br />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 />“rLppfrfin6a?foryou^wa5f^^^^ folW^g: <br />A) The chief executive officer of the city or township within which <br />Bi The ^oci!nIr6f°l;hrB;ard of Managers of the watershed <'istrict <br />^ If any! wl?hL which your project is located or which your project <br />may affect. <br />You MUST certify having served the complete application on the above in the box on the back <br />side'^Fthe application form W-54. <br />r- • ft.. K'OT located in a city, a complete copy and all supporting <br />Jatro^ire^ppirc^i^onrouirbfluWtted 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 />****************** <br />************ <br />SECTION I (TO BE COl^LETED BY APPLICAliT) <br />TO:A) Chief executive officer of X\\e<check)^ <br />C3 city, O township of (( //Yj': ^(pi*int or typB. yicoTis)^ <br />, j c the>Li^ t'//i//' ■^ ( /ilf*/^watershed district.B) Secretary of the board of managers of <br />county. <br />0 Administrator of the shoreland management program <br />)!O <br />FROM: ^}\i^ <br />/) ^ o <br />'/v; • V - KiOcC'd ------q <br />’(piknt or ty^fI neem and address of aopl%CLmtj <br />Dat e:/^-/-3 isTZ <br />******* <br />INSTRUCTIONS FOR THE LOCAL GOVERNMENT <br />This report from provides you an opportunity donrthe''!e!!e!wd°pe™it!*’ <br />Resources to assist in deciding whether to gran , mo j jj approve or disapprove the <br />It is NOT absolutely necessary for local agencies to f dLired Ic is requested <br />pro ect or make any recommendation, although this may be done if desired. q <br />that local agencies indicate the following, as applic.able. <br />A The relationship of the proposed project to local plans for the <br />b’. ?L^^!:!at!:n:Mro/!hf;!o]:ct-to local mnd use controls including <br />flood plain and/or shoreland regulations. <br />(contiriued on reven'e szde) <br />S\f <br />........*************** <br />^ ^1 <br />11 <br />§ <br />5- <br />A <br />,k- <br /># <br />% <br />! > <br />r -3t.-h': d: <br />■ " <br />.’n- <br />' Jk ' <br />'‘f <br />% <br />Vdy-'. <br />If M <br />9 <br />V ■ • <br />C. <br />D. <br />E. <br />F. <br />Please comolc <br />this page wit <br />needed. <br />* * <br />SECTION II ( <br />The applicant <br />application o <br />are submitted <br />(Attach add <br />RETURN TO: <br />DEPARTMENT OF <br />Division of W <br />Regulations U <br />Centennial Bu <br />St. Paul, MN