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M4 <br />JL <br />�9SNEO <br />MINNEHAHA CREEK <br />WATERSHED DISTRICT <br />P.O. Box 387 <br />Wayzata, Minnesota 55391 <br />(FOR OFFICE USE ONLY) <br />PermIMpplica <br />Date Received <br />Notice Sent _ <br />Agenda Date <br />ion No. <br />L <br />APPLICATION FOR PERMIT <br />(See Reverse Side For .nstructions) (Do Not Write Above This Line) <br />1. Owner: <br />(pro of type) <br />(Aaa.eSS1 (Cny) <br />(telephone) Opi <br />(owner Signature) <br />3. Permit Requested For: (Check All Appropriate Boxes) <br />B. Stormwater Management Plan <br />rn Commercial <br />C Industrial <br />❑ Institutional or Highway <br />r>< Residential <br />C. ❑ Floodplain Alteration <br />2. Owner's <br />Representative . L'y� fir 4 Cf,'6rye nec- <br />�ir�i T.Y/2V f:•' C'.t' /. c- r L der 1 .4& <br />IAoorese) (CRY) <br />y7f - S s�?S, 4 <br />(Te 0-0) (2.P) <br />,N PE. .E� R.L.S. <br />D. .�(-Wetland Alteration <br />E. X Dredging <br />❑ L.A. ❑ Other <br />F. ❑ Shoreline/Bank Improvement <br />G. ❑ Stream/Lake Crossing <br />4. Project Lo ;ation: O�'''�'/�' f ����� 4/w 11 -7 Z <br />(Crtr) (courwy) (v. Svc) (Sec) (townMM) (Reno) <br />5. Describe the Project: rAf- re---.; /.lra.�✓,,���' L0 -F ANO <br />Td e� or1*IW L�f7rr//�,/ j �. 7Cd7, /'•fir l'%� �L%� <br />t,se-ic `<•;r ir Cs/i< c 9.47f' <br />6. If This Project Pequires Municipal Approval or Review, Attach Documentataion of Municipal Review. <br />7. Body of Water, Stream or Wetland Affected by Runoff From This Site: ���'�*1' 426'741&4 <br />7V ram' F are'• -T Distance From Project: / ." <br />0, Schedule For Construction, Implementation of Temporary Erosion Controls, Substantial Completion and Restora- <br />lion: 7,V ' ' F.r'' • <br />Please call (612) 473.4224 if assistance In completing this form is required. In submitting this term, the applicant <br />1111110thowletlges all requirements for permit approval as determined by the publishod Rules dated February 20. 1986. <br />brm 111041111 <br />