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<br />DNR,
<br />juri$4ic
<br />form
<br />Shad
<br />R£QUI
<br />JNED JOINT NOTlft-.,.A TION FORM-WATER USOUR( A.PPLICATION w
<br />notify/apply lo 1he M~ha.ba C~k W a1.:isbed Oislrict (MCWD)~ 1heir engineering consu1,an1s.1he
<br />ennepin ~ion District of a proposed \\'ater/wetlaod project or wmt \\1hich may fall withil'l 1heir
<br />· agenc:ica should advise )'Oil -of their juris<lidion or pennil requircmc:nt5 within 10 cla)"S. Fill aut this
<br />sad mail a OOP)'~ -with plan, maps. etc .•. 10 the MCWD, Gray FreshMlcr Omti:r, Navarre. 2S00
<br />I, Suili: 37, Exeelsior, MN !5331. Keep• cupy for )•our records. YOU MUST OBTAIN ALL
<br />l'HORIZAnONS B£FOR'E BE(UNNIN(j WORK. .
<br />A~{S1Mlt.kP1>.0.t1x#.CJty.SUlt",Zfp,~ z.1eo ;,t:(/Jtb,D:JIJ tOAYl (;#JAJO ,rw 552,~
<br />2. u:,cati,;n l,r prop~,:1~ pri..,jcct t'A1tilll':b dr.av.ing w/dirocdons ELH-iti:): 117,J ~Zr W S · "I ~ ~ Ail.I~
<br />("OUNT,J QT~ ~&J'ION(..~) SEC110N{s) 3 'fOWNSl UI"($_) RANQ~_s) . L~. BJ(lclt, Subdivision ~Ais,,,..,,...,
<br />l'r~'.l /\DDRf:SS: 2.lc!:O HI/A.Jb'lf»J alA1t·nv· . . ·-{,: ... ·;· rlAJ 5'5 3S"<e?
<br />l. iENGl"H Of $HORE AFF:Eci;l:Jl ti'.r1fi:cl): . VOLI..IME ()f.-1·11-l Olll:XCA VA ;nol'q(."1:ibia: }-:ttd,,= . JI 000
<br />.t\kf.A FlJJ.f:D Ok F .. 'XCAVA'fl!:() JS ~ Am-s. OR Sq\tilN Fu~-
<br />4. 'fYJ'B OF N!-l'.MJ'f IJEJNO hPPUEV FOL~: ~ll1cck iill thi'lt awl~·l:
<br />0 SJ'OltMWhU:R.MANAGE..\1P.~T l>LAN O FtOODl'l.AlS ALl~µATlO~
<br />OSJJoREU~B IMl-'R0VEMENT
<br />aOJUPRAP
<br />C.sroEt.'1 s~WER OUTF AU.s
<br />b.0sANDBLANXET Ottf. JUOOB REMOVAL
<br />~□JU:.T A.r.lllSO WAl.L
<br />~~I!&. Clfl. \'"ElUCROSSINCiS
<br />OTHER{l)ESCRUlEt ~\of.J ~,;r~k « ~1!1'0N
<br />S. PROJECT lJURPOSE (wby is Ibis project n«dcd -'i\'hat bct1elits \\'ill il pro,.idc1)
<br />~~~'?'Ct'J~-
<br />D Wfi"llAND AL lERA"llON
<br />0 BXC'AVATION (LlllEOO(NOl
<br />sOWllDUFE b.0 NA\'IGATlON eO BlOl~NOlNEERJKO
<br />6. ALTEJtNATJVES (~!ICr.ibe any o1he« ,,1es or meth,.1J11 that could be u..~d 1,, cll.':hiia,.~ she l'lllf'l,111l ,,r )',,ur rroj~i:• whi!t a\',1idinl? -1.'f
<br />minitnizinJ Wllt~/\\'1:lland ilnpM:L"I:. Attai:h additional sbi:dsi, if tteL-ded.
<br />7, DA'ffiS l~d s~nofae1i•,i1y: ~ ~Ufr l'I-Ctpci~,J co1npletion: l
<br />tldcntifv 0Clffl lcr.cd \\\Mk on a1ta~d draw· )
<br />8. NAMES & ADDRESSES OF ADJOINING PROl1.ERTY OWNERS ~·A1ia~1, list if more)
<br />9. PERMITS HAVE BEEN RECEt\""ED,.(R) OR APPLIED FOR (A_) FROM: __,ONR _ ARMY C-ORPS OFENGR
<br />_ C'OUNl'V _ CITY _.:_MN POLU.ITION CONTROL AOENCY .
<br />I hc:1:eby DDti.ly tlll: rccipk:EIII-Df this fonn-ot· lbe project prq,mal bcR:in .and request l t,e advis,d oJ' any pc:rmils « Olber dci.emuaatiicm-
<br />·~wming t)1is ptaj~t 1ba• I ,lfflM oliaa.in. I UlkfimtaDd that Pl\~iDs wilh wQl'k befoN rul ftl,)lliHd aLllhodzati(JnS are '>~i,wd ma)' lie
<br />subji:.,:t to Ecdtral, 1:01l'fillf«local admini&lnllM, ch.ii aadlor criminal pcnallics.
<br />~,z,.vov--t ~
<br />Date
<br />CT3HS~31~M ~33~J ~H~H3NNIW
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