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NA-92670-01 (W-221) STATE OF MINNESOTA (Rev 74) DEPARTMENT of NATURAL RESUURCES NOTIFICATION OF PERMIT APPLICATION INSTRUCTIONS FOR THE APPLICANT Minnesota Statutes, Section 10S.44, Subdivision 1, requires yo;; to supply a complete copy and all supporting data of your water permit application to the following: A) The chief executive officer of the city or township within which the project is located. B) The secretary of the Board of Managers of the watershed district, if any, within which your project is located or which youe• project may affect. You MUST certify having served the complete application on the above in the box on the back side'oT—the application form W-S4. iN ADDITION, if your project is NOT located in a city, a complete capy and all supporting data of the application should be submitted to the Administrator of the Shoreland Manage- ment Program for the affected county. Complete this form for each notice served on a local government official. SECTION I (TO BE COMPLETED BY APPLICANT) TO: A) Chief executive officer of the (check) QC city, [Q township of Orono print or type mane Minnahsba 8) Secretary of .,,e board of managers of the Creak watershed district. print or type ncane C) Administrator of the shoreland management program of Hennepin county. ?print or type David J. Dunlap 1595 Bohn's Point Road FROM: Wayzata, Minnesota 55391 Date: July �19_ L i przn or type mvne cmd address of app zcant # # # # r # # # # w # # # • # # # # r # # r r # a # a # • • a INSTRUCTIONS FOR THE LOCAL GOVERNMENT This report from provides iou an opportunity to submit input to the Department of Natural Resources to assist in deL _ing whether to grant, modify, or deny the requested permit. t is NOT absolutely cessar• for local agencies to officially approve or disapprove the project or make any ._commendation, although this may be done if desired. It is requested that local agencies indicate the following, as applicable: A. The relationship of the proposed project to local plans for the affected water and related land. B. The relationship of the protect to local land use controls including flood plain and/or shoreland regulations. (continued on reverse side)