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MAY-31-2005 10�25 P.02/02 <br /> rerm�t� v <br /> Sandblanket Permit and Sand Source Exhibit For �� <br /> FAST TRACK PERMI'�' o �G L g �� <br /> MINNEHAHA CREEK WATERSHED DISTRICT (MCWD) APR 1 1 2005 <br /> 18202 MINNETONKA BLVD. Ph: 952-471-059a <br /> DEEPHAVEN, MN 55391 Fax: 952-471-0682 �- - � <br /> I,�.O'�11qU.V��reside at �o54z �bTA'Ti:. fl� , GD�,� ��4it�i� <br /> (Property Owner) (q�) (CKY) <br /> �l , (��7. - request approval to install a sandblanket on property described <br /> (3tate,Zip (Phone <br /> as 1265 Bracketts Point Road , Iocated in Orono , Hennepin <br /> , (Stroetaddress) (VYdhin the Cily boundaries) (Counry) <br /> 11-117-23-32-0010 on Lake Minnetvnka , __Smith Bay <br /> (Propertyr ID#[FID#}) (Laks) (Bay) <br /> I have contracted with G�,fS�l A�,.l�.�f. Ti'�e_� ��t � ��O�i 1"'�1�� 1� <br /> �Name ot Comperry (Street addres�s) <br /> 553 , (��•'�1q- 1 1 b'� to instai� clean sand firom the <br /> CRy, ta 2ip) Phona) <br /> following source ���Tr01� Sq�10�GVL�e�w1�sC1�. �.nol .T'']aA� G�Vc. 1�1r�1 <br /> `l.-�` �� �I� ' �Suppller) (Address) (�iq'�LP) <br /> 1 <br /> (Phone) <br /> I will install the sandblanket from the following source w S"'��.Co��.+l� �.A�1�jC.�Pt ���u{ <br /> (6uppli <br /> � ���1� '��q ��1. , �,Fil�1���•G� M�r1 55319(__7� 4''�li �O� <br /> (Addro�) ' (City,State,Zlp) ( one) <br /> My shoreline is 7a3 feet and the dimensions of the proposed sand�lanket are: 50' X <br /> (Length) <br /> 6�� X ��' . Sandblanket dimensions cannot exceed a lengtli of 50' (or 50°� of shoreline), <br /> e�th�— � t <br /> a width of 10' and a depth of 6°. If this project requires municipal approval or review, please attach <br /> documentation of the municipal approval with this application. <br /> I unde�stand that if this application ls not completely filled out, or if I fail to submit the �equired exhibits, the <br /> application is incomplete and will be retumed. It will not be reviewed by MCWD staff until comptete. By <br /> signing this application, I agree and understand that the District may enter the property at reasonable hours <br /> to conduct an inspection to determine whether the terms of the permit are befng met. t further understand that <br /> if 1 violate the terrns and conditions of the permit that is issued based �pon this application� the Distriet shall <br /> conduct a fleld inspection of the project per MCWD Rule J, provided with thfs appltcatlon. I understand the <br /> District will charge fees to cover the actual costs of field inspectiorvs, including investigation of the area <br /> affected by the work, analysis of the work, including the services of legal counsel a�d engineers, and any <br /> subsequent monitoring of the work. The District's actual costs are deerned ta b�gin accruing when the District <br /> issues notice iolatio to permittee. I have read and understan� th MCWD Technical Guidelines for <br /> bla � <br /> (Signatu�of Prop Owner) (Date) <br /> Subscribed and swarn to before me this �' day of ���r, 1 , 20 U�_. <br /> � � JOUYAVYERNER <br /> NoWry Public <br /> PUbIIC � Mlnnesota <br /> � J . , MY Camm,Fxpires Jon St�2010 <br /> APProved by: �� Date �J�`�D/'L� <br />