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ev <br /> Permit# - <br /> Sandblanket Permit and Sand Source Exhibit Form <br /> FAST TRACK PERMIT <br /> MINNEHAHA CREEK WATERSHED DISTRICT (MCWD) <br /> 15320 MINNETONKA BLVD. Ph: 952-471-0590 I' <br /> MINNETONKA, MN 55391 Fax: 952-471-0682 j <br /> I,Sc�rRch ��«b�� reside at ,�t�a.�15 �.�.r'tim��-rt �ul_ C�n,c,�: <br /> (Property Owner) (Address) (City) <br /> M A1 '-���'�31 , (�) 3�c, y�q I request approval to instali a sandblanket on property described <br /> (State,Zip) (Phone) � <br /> as �,ct�m,c� , located in C'�n.��c� <br /> (Street address) (Within the City boundaries) (County) <br /> �c� 1 l"I �.3 ��(U� i''E on 7Y1�-�<� � L'0✓t�m�� <br /> (Property ID#[PID#]) �'j�CEPT LANDSC����NG <br /> �I have contracted with P.O. Box 43Q , <br /> (Name i� y mne�ta 55 64 (Street address) <br /> , ( ) to install clean sand from the <br /> (Ciry,State,Zip) (Phone) <br /> following source �`(1 wc,l,Qr� 5�..�� , C�r:r.�tc:. <br /> (Supplier) (Address) (City,Zip) <br /> (� �) � 8 - � 5 <br /> ( hone) <br /> I will in sandblan m the follo � g s urce _ � <br /> (Suppli r) <br /> , � <br /> (Address) (City,Slate,Zip) (Phone) <br /> M shoreline is t <br /> y i�l 0 feet and the dimensions of the proposed sandblanket are: �p _X <br /> (Length) <br /> �_X �o S . Sandblanket dimensions cannot exceed a length of 50' (or 50% of shoreline), � <br /> (Depth) (Width) 't <br /> a width of 10' and a depth of 6". If this project requires municipal approval or review, please attach f� <br /> documentation of the municipal approval with this application. " <br /> I understand that if this application is not completely filled out, or if I fail to submit the required exhibits, the <br /> application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. By <br /> signing this application, I agree and understand that the District may enter the property at reasonable hours <br /> to conduct an inspection to determine whether the terms of the permit are being met. I further understand that <br /> if I violate the terms and conditions of the permit that is issued based upon this appli�ation, the District shafl <br /> conduct a field inspection of the project per MCWD Rule J, provided with this application. I understand the <br /> District will charge fees to cover the actual costs of field inspections, including investigation of the area <br /> affected by the work, analysis of the work, including the services of legal counsel and engineers, and any <br /> subsequent monitoring of the work. The District's actual costs are deemed to begin accruing when the District <br /> , issues notice of the violation to permittee. I have read and understand the MCWD Technical Guidelines for <br /> sand lankets. � �� �� <br /> (Signature of Property Owner) (Date) <br /> Sub ribed and swom to before me on this day of , 20 ii <br /> „ � <br /> � � �� � � � <br /> Notary Public € > � <br /> �� � �, �� <br /> �` �uN � a zc;� <br /> ��t� ��_ . <br /> Approved by: Date <br /> , �..__� .___. ._ �..._�___. ; <br /> .��. .._._.�a. �. ,. .._,. , _...,...,,..� <br />