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JUL-05-2000 10�59 MINNEHAHA CREEK WATERSHED 6124710682 P.02i02 <br /> WaTEF1wF1=�, ���TI�iC"f <br /> S1�IVDSLAIVI�T P�RMTI' & SAND SOURCE�iIBY'T Fd�.i111'v 200� <br /> � Nf.� CREEIC WATERSHED DISTRICT <br /> --,�'�.��,��Y <br /> _ �'��� <br /> 1, „� b � e� <br /> D 8l� R 1 7` residittg at ��l3�n � , bro�o ,�,5�,4,5'3�/ <br /> F'roperty Owner Addcrss City,St�tc,Zip �— <br /> ( � 7S��� . l�•/e�/N , ��1'DYJ/� or PID#O�117�39�D� <br /> Phone County Township,Section,Rsr�gc (from property tax stiilqmcnU <br /> owtt and occupy the above single family residence and wish to install a sandblanket ori <br /> Grys�1 a�, �r��3 <br /> Lakc&6ay • <br /> � T have contracEed with �s' �,��7� at_,37/�'D �.P��(�J 6�aY�� <br /> contrxctur addrrss <br /> ���S%D/' �N SS� ,3�, ��� -79,�9 ta instaIl cleah sand from t�tc following s�urcc <br /> ciry,state,zip phonc <br /> �_t�'� 1�1 v����t �31 �a�� �c/� %�zh'1 �Jv�'� , J �o . -�76zo or: <br /> su�l,er adcl�r.ss plioac � <br /> ❑ f will instdll the sandblanket myself from the following sourcc. <br /> ' su},Pt�cr .� <br /> ^�> > <br /> tic�es s phonc <br /> If lhis project rec{uires municip�l app.roval o�^ review, plefl.se attach documentation of the muriicipal appmv�: <br /> wil�h th.i,s applic:ation. My shorclinc is�O� feet and lhe dimensions of th.e prppos�:d satic�blankef arc: <br /> ii <br /> �D/ (Length) x �� � (Width) x�,�,_ (UeplFt), Sandblankc;l dimettsions c�.nnol exceed a <br /> length of 50' (or 509ti of shoreline),A width of 1.0'and a deptl� af 6"_ <br /> I undersland tha.t if this applieation is not comp�etely filled out, or iE I fail to subm►l lhe rec{uired exhibit; <br /> the appIication is incomplete and will be rcturned. Il will not bc: reviewed by MCWD staff until complelc <br /> Iiy signtng this a�plication, I agrec and understand that the District may enter the property a[ rcasonahl <br /> hours to eonduct an inspection to dctermine whetk�er the terms of the permit Are being met_ I furthe <br /> undersiand�that if [ violatc Ehe terrtts and conditions of a permit (hal is issued based upon this applicatior <br /> the Distriet shall conduct a field inspzclion oF the project per MCWD Rule f, provided wiEh this applicatior <br /> [ understand the District will charge fees lo eover lhe �.ctual costs of field inspections, includin�; investigatio� <br /> of'thc; area affect�:d by the work, analysis of the work, including the services of legal counsel and engincer: <br /> and any subsequc,nE monitoring of the work. The District's actuai costs are deeme:d to b�gin acc�liing whc� <br /> kh l�istriet issues notice of the violation lo thc> permittee_ [ havr; read and uttdcrst�nd thc MC:WI) '!'eehnica <br /> G de nes fo san s:- <br /> � a�-� <br /> $ig ature of p perty owner �a�.� <br /> Subscribed and swortt to before me this �da of�-+'��C- 200.�+ <br /> � SHERYL A.I.ATT�qNER <br /> Q , NOTARY PU9UGMINNESOTA <br /> MY COMMIB�ION E7CPIRE61-01,ZG06 <br /> otary F'u Iic . . . � . � � <br /> � 6 �_ <br /> Approved a d Accepled by i�atc <br /> James Hafner, District Teehnieian <br /> TnTAi P A� <br />