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�. , MINNEHAHA CREEK WATERSHED DISTRICT <br /> ' . 15500 Wayzata BoulAvard • <br /> Suite 611 Twelve Oaks Center e'"'��a�'�bO"No. <br /> Wayzata, Minnesota 55391 a��"'�- <br /> o t 1 c <br /> nt <br /> Date <br /> APPUCATION FOR PERM(T- FORM A - <br /> SEE REVERSE SIDE FOR INSTRUCTIONS <br /> �����L. <br /> 1. OWNER: � 2. OWNER'S - <br /> -�c r� � REPRESENTATNE: �v' , <br /> 32�`i C �,L�� C' �•c /� '�,� �'-� � `� � � <br /> w�� c� �� c"�'� . �1�, r'^'� <br /> �'.� _c' c_ 1'�1 � j S ..�� i 7 �. <br /> .ta <br /> R.�.�w 4%/— 4 � .m°' R«•�w caw <br /> Owners Signature� � , o P.E. ❑ R.LS. ❑ LA. ❑ OTHER <br /> 3. Projed Location: / <br /> ,�4 sec. v`�^;;: l'�� ��Nfi� <br /> C � ��� . Sec. Townshi ���"� Ran e 2, <br /> . <br /> 4. Pro'ed Address: " �%�� l ��t� ''' / � � , <br /> 5. Permit Requested For: (Check all appropriate boxes) w� � <br /> U� � <br /> B. ❑ Stormwater Management Plan C. ❑ F{oodplain Afteration r. <br /> 0 Commercial D. ❑ Wettand Afteration Q o .— <br /> ❑ Industrial E. ❑ Dredging Q= d <br /> = Z <br /> ❑ Institutionai or Highway F. ShorelineBank Improvement W Q � <br /> �Residential G. ❑ Stream/Lake Crossings � Q � <br /> NOTE: A l i c a n t s L a i n S a n d b l a n k e t s M u s t U s e A l i c a t i o n F o r P e r m i t - F o r m B � <br /> 6. Describe the Project: <br /> � .. � _ F y� � <br /> ,C., _ U' �� y <br /> ?. U _ <br /> 1 <br /> (If this project requires municipal approval or rev(ew� attach documentation of munictpal review.) <br /> 7. Body of water, stream or wetland affeded by rvnoff from this sfte: _ ��e �1.,,}�� <br /> Distance from project: �i�Q7,/,��h� -� <br /> . <br /> 8. Schedule for constn�ction, implementation of temporary erosion control, substantial completion and restoration: <br /> � � <br /> � , <br /> �' � S <br />