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• � Print Form <br /> � ORONO COPY <br /> WATER RESOURCE PERMIT APPLICATION—COMBINED JOINT NOTIFICATION FORM <br /> Use this form to notify/apply to the Minnehaha Creek Watershed Dis�ict(MCWD),their engineering consultants,and the DNR ofa <br /> proposed project or work which may fall within their jurisdiction.These agencies should advise you of their jurisdiction or permit <br /> requirements within 10 days.Fill out this form completely and mail with your site plan,maps,etc...to the MCWD,18202 Minnetonka <br /> Boulevard,Deephaven,MN 55391.Keep a copy for your records. <br /> YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. <br /> 1.Property Owner Name(First,Last): <br /> Mailing Address: City: State: Zip: <br /> Email Address: Phone: Fax: <br /> 2.Location of proposed project(Attach map with directions to site): <br /> Project Address: City: <br /> County: Qtr Secrion(s): Section(s): Township(s): Range(s): <br /> Lot: Block: Subdivision: PID: <br /> 3.Size of site: Area of disturbance: square feet,or acres <br /> Volume of excavation(or fill): cubic yards Lengkh of shoreline affected: feet <br /> Area of existin im ervious surface: Area of ro sed im ervious surface: <br /> 4.Type of permit being applied for(Check all that a ly): <br /> � EROSION CONTROL �WETLAND ALTERATION <br /> STORMWATER MANAGEMENT ❑WATERBODY CROSSING <br /> FLOODPLAIN ALTERATION []SHORELINE/STREAMBANK IMPROVEMENTS <br /> DREDGING <br /> OTHER(DESCRIBE : <br /> 5.Project Purpose(Check all that apply): <br /> SINGLE FAMILY HOME �MULTI FAMILY RESIDENTIAL HOUSING(apartments,etc. <br /> COMMERCIAL CONSTRUCTION �INSTITUTIONAL CONSTRUCTION(churches,schools,etc.) <br /> ROAD CONSTRUCTION �SUBDNISIONS(include number of lots) <br /> ❑ UTILITIES �LANDSCAPING(pools,berms,etc.) <br /> DREDGING ❑SHORELINE STABILIZATION(lakescaping,bioengineering) <br /> OTHER DESCRIBE : <br /> 6.NPDES/SDS General Stormwater Permit number if a licable : <br /> 7.Alternatives(Describe any other sites or methods that could be used to avoid ar minimize impacts to water <br /> bodies to achieve the project purposed.Attach additional sheet ifneeded.) <br /> 8.Project Timeline: Start Date: Co letion Date: <br /> 9.Applicants Representative(�icensed contractor,engineer,etc...) <br /> Business Name:5tonewood,LLC Representative Name:Sven Gustafson <br /> ayza a v Minneapolis <br /> Business Address: City: State: Zip• <br /> Email Address: sven s onew .com Phone: Fax: ��7"553i— <br /> 10.Names and addresses of adjoining property owners(Attach list if necessary): <br /> Permits have been applied:City�County MN Pollution Control Agency�_DNR COE_p._ <br /> Permits have been received:Ci Coun MN Poliution Control A enc DNR COE <br /> I hereby notify the recipients of this form of.the project proposed herein and request I be advised of any permits or other <br /> determinations concerning this pmject th��I must obtain.I understand that proceeding with work before all requirad authorizations <br /> are obtain may s ject to Feder�t;State and/or local administrative,civil and/or criminal penalties. <br /> / p � <br /> `_- L� J � <br /> Si ature of Pro Owner Date <br /> Page 1 of2 <br />