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THp!-i=�-�:�_��=�t=� 1?� 1�=� f�1Ih•lhJEHHHA t_REEI<:: I,.JHTER.'=;HEL.� ��1�4�1�=�r��_� F'.�=�1,'��1 <br /> Permit # 00- �// <br /> �T SMQR��.fNE EROSIDN PR07EC�'IdN-FAST TR.laCK P�RMIT I <br /> MlNNEHAHA Gf2EEK WA�"�RSH�U I�fSTRtCT <br /> GRAY FRESHWATER G�NTER Ph: �71-059Q <br /> 2500 SHADYW04D ROQD FAX: 479-a682 <br /> EXCELSIUR, MN 55331 <br /> i, ����,,� �;.�.ri-r,�.� ��k reside at�,�.� r �a�.� Pp �r` � . <br /> (Property Owner) �— (Street Address} <br /> c.'�,J..6.� , -�,„. . .�s3� r �'7! - OD�.� request approval to in�t�11 <br /> (City) (State) (Zip} (f'hone) <br /> riprap shorelir�a �rosion protectian on property described as��y� Ca�� en . , iocated in <br /> (street address) <br /> �J�m o , ,�o t�-I a� �4� o o Sa . The rip rap installation <br /> (Within the City bounda�ies} (County� (PID#} <br /> wifl consist of 1ao� along the shor�line of ^yY���a_ _ _ . , ('anrm� in tulf <br /> (lineal feet} {L2ke} (Bay) <br /> accordance with the Minnehaha Creek Wafiershed District Shorelin� (�rotection Guideline for <br /> riprap placem�nt required for issuance of a �ast Track General Permiti. I hav� cantr�cted with <br /> �rn�:.<-�$ L.a��sc.o���-�. � 31 S 3 b • � �-.a.rt- ��o K.,.-� , �f 7 z,�l�..��._. . � <br /> — {f�ame aP Company) (Address} {Phone} <br /> �►. ,S� , to perForm tt�e wark who is f�mifiar with the technical requirements <br /> (Ban Number} <br /> and has fulfilled th� banding requirem�nts of the wate�sh�d district tsee reverse). 1 have read <br /> and understand the req irements of the MCWD relating to Shc�refine Erosian Protection_ <br /> ��� � <br /> (Signature o Praperty Ownor} (D�fE) <br /> Subscrib d �nd sworr� to befpre me on this � � day of 2��� <br /> _ r-T;-,�,:_i_� - <br /> � el ti�v� � _ , =:i�,.T <br /> :aMES �!!TH <br /> riorAAY GI <br /> Notar,y Pubfic • _ r '� ' p# !�'i�� <br /> a� ,,. ;^• <br /> ..... ._,..�... - �� - <br /> /approved By: � . �� Date: � ..p <br /> i .., -----_�--� <br /> Distribution� ,..,,Prope�ry Owrter _�otttraclor _Municipalsry _DNR _District f•ilc <br /> TUTHL F'.�=�1 <br />