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ANA <br />7r .1L <br />r9SyE 0 DES` ... <br />MINNEHAHA CREEK <br />WATERSHED DISTRICT <br />P.O. Box 387 <br />Wayzata, Minnesota 55391 <br />(See Reverse Side For Instructions) <br />1. Owner <br />(P-1 or Type) <br />Iraa�ssi IC,iil <br />1T14Pnone) (z.P) <br />(owna srOn,t6r.) <br />,r Vft. <br />(FOf, OFFICE USE ONLY) <br />Permit pplication No. <br />Date Received <br />Notice Sent <br />Agenda Date <br />APPLICATION FOR PERMIT <br />3. Permit Requested For: (Check All Appropriate Boxes) <br />B. Stcrm::ater t."anagement Plan <br />C Commercial <br />C Industrial <br />C Institutional or Highway <br />Residential <br />C. C Floodplain Alteration <br />(Do Not Write Above This Line) <br />2. Owner's <br />Representative <br />/rf�' T.�l%i fi rr /�J� L c' �✓r' e Ak <br />(� (Aoor�st) IGbI <br />(TaUpnonc) I�PI <br />PE. R.L.S. ❑ L.A. ❑ Other <br />D. -�<Wetland Alteration <br />E. )< Dredging <br />F. ❑ Shoreline/Bank Improvement <br />G. ❑ Stream/Lake Crossing <br />4 Project Location: O��'�i0 (�//�/�� %✓ �✓�_ 3 1,17 <br />(c,10 (coumY) {w Sac) (500 (TownsMp) (Sins;) <br />5. Describe the Protect: >�f— <br />'.fF -r Id /�r&0�r%r^" �!/r f'fyi✓/�i✓ j 7/r/ �S•�rCJ'(! rn/i <br />6 If This Project Requires Municipal Approval or Review, Attach, Documentataion of Municipal Review <br />7. Body of Water, Stream or Wetland Affected by Runoff From This Site: c'�f<rr i��•%=ie% <br />T^ %f f' -^r _.._. _ Distance From Project: <br />8 Schedule For Construction, Implementation of Temporary Erosion Controls, Substantial Completion and Restora <br />- <br />tion _ T4 � ------ <br />Please (.all (612) 473.4224 it asto,,Iance in completin3 this lotm is required, In BuVmrtUng this tutnl, thu aapiscant <br />ickno*ieayes all requirements for permit approval as deitmnined by the published Mules dated February 20. 1986 <br />L <br />forr" f -0 <br />