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�EHA1fA C9 <br />. t <br />i. <br />� C� f D Ohs <br />MINNEHAHA CREEK <br />WATERSHED DISTRICT <br />P.O. Box 387 <br />Wayzata, Minnesota 5539: <br />(See Reverse Side For Instructions) <br />(FOR OFFICE USE ONLY) <br />Permit Application No. _ <br />Date Received <br />Notice Sent <br />Agenda Date <br />APPLICATION FOR PERMIT <br />It <br />(Do Not Write Above This Line) <br />1. Owner: Washington Scientific Ind. I12C Owner's <br />(Print or lypel Representative Joe Pallansch <br />2605 West Wayzata Blvd, PO Box 340 260E W. Wayzata Blvd. <br />(Add,ssl (Cdy( -- — — (AAd,essi iCdyt <br />Long Lake MN 55356 473-1271 Low Lake MN 55356 <br />(Telephone) IZrpt ITeieptwnel 2ip) <br />i <br />(owner sognaturo) --- PE. R.L.S. ❑ L.A. Other <br />3. Permit Requested For: (Check All Appropriate Boxes) <br />B. Stormwater Management Plan <br />❑ Commercial <br />® Industrial <br />❑ Institutional or Highway <br />❑ Resir'-,ntial <br />C. ❑ Floodplain Alteration <br />D. U Wetland Alteration <br />E. [.! Dredging <br />F Shoreline/Bank Improvement <br />G Stream/Lake Crossing <br />4. Project Location: Long Lake I Hen 1S } of NE 33 ' 8N __ __ _.__ L__ 2 3W_ <br />(Gty) (County: c. Coo (sect ,Townsh-pi fRangel <br />5. Describe the Project: Add 32,000 sq. ft. addition to present .juilding <br />6. If This Project Rw,u)res Municipal Apprcval Review, Attach Documention of Municipal Review <br />7. Body of Water, Stream or Wetland Affected by Sunoff From Tnis Site: I ong Lake <br />From Project. ____ 1 } - 2 miles _- <br />8. Schedule For Construction, Implementation of Temporary Erosion Controls, Substantial Completion and Restora <br />tion: Building permit July_)_8/88 for City of Orono - — <br />Complete date October 1/83; _— __ <br />Iow Please call (612) 473 a22,i if assistance in comhlw mq thts foam is required In submitting this form the af+plicant <br />d. i nowledges all requirements for permit approval as determined by the published Ruies dated February 20. 1966 <br />Form rM f^ <br />