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._THtJ-1=�-�t_u_u_� 1�:Gr� f�l I h IhJEHHHA �:_F'EEE<.: I.1IATERSHEL:� ��1���14=�r�2� F'.�_�1:'t_�1
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<br /> 51�NI)�3��AN'KEZ` PE�.�'�' 8c St1ND SQLJRCE F�ISIT F�F._I1i�:�
<br /> NfYIVI�I�EH,AHt1 CREEK W.A.'I'�RSHEl7 DYS'�RIC'T
<br /> I�F-,RNiIT�oa-� o�o
<br /> i �'f1�V� �� e ��.� resi�jin� at 3� f �a�� �� � � ___, _.Q/w-►cc SS391 --
<br /> ti .
<br /> 4'ri:�?Ct'[Y Cl�ultCr Addr�„s C=ity,StRtt, 7_ij?
<br /> �r� � - �o �� . ���- , �,z ��r��# aorr � a� �� a� sQ
<br /> Phottc Coutit}� Tt�wtishlE�,SC�:tiott, Rsngz (fttitit ptl7Exrty tax alnlemctlt)
<br /> own artd accupy ihe ak�ove siiiglc family residence �nd wis�i to iristall a s3k1C��1�ril:et Otz
<br /> � ��cL ^ � ctn�rti�� G03�S3pPR�STSLAANE G
<br /> (�keRcsay N1pUND, MiV 55�i
<br /> � o sc.,.}�.�.--�at '�f 5 � ,ft c�z..a�S.
<br /> �J I �tave contraeted ��itli �.trn���o� �- ✓`�'
<br /> �1i�[itIriC1�1Y (i�/�d�1:S:;
<br /> �o ���L ���Cd'-} , f-F 7 z -` I �6 _ to ir�sf;�ll clean Szr�d frotzz ttte follo��-ing sou;
<br /> rity,Sl�ft�.,Zip pho�le
<br /> -�(�„�,2,Qsh S a� �, a.a-�� , . �{�{�-'�1 7 � , or:
<br /> supplicr address �'tion�
<br /> L� I �Aritl ii}bt��Il tlle s�nf'l�lanket rnyself irotn t�te followit�.g sourc;c:, ,___..
<br /> �� � supplic r
<br /> / �
<br /> t1C�!'�ts � E,}Z�nc
<br /> If this t�r�,jec:t rcquires murlieipal ap�,r.o�ral or rc.vicv�r, Plezse att:sc��� cit�cuxttentatio�l oi r�,{- �z,.t�rlicipal appr
<br /> ��rlt}'1 f�11S a�7�'�IIC1fIOt1. NIy SFIOf`eilll(: 1S __,I.z-� fCCf �IZC3 E�lt. C�1C1'1Z11S10Y15 OE fEl�. �?l.`c7F?OSC.C� S:3ri��L7��2'1�:C1 L3J'�-
<br /> -�O � ��.z.Yl,yf�'l} X 1 U ' ��[t�t�l� 3t � 1'_— �n��t}l�. S£1fiC��Jliitt�:�t C�1 iTl�2lS10Y1� c:<iilili7t �:;CezL� �1
<br /> let't`f�l 4F �4�� (oz' �O�iv ot 5lrtot�eline),a wi.dtlZ of I O' �nd a dcplh ot f-,".
<br /> [ ur�dcrstand that lf t�liS 3�3�7�,1CfitiOIl iS f10t co��lplefely fiiled out, pt' i£ f fail to �ubmi! l��e r.'e��uired e�h
<br /> the applicaiion is incom�lete and will �e retuerled. [t will noE l�c: reviewed �y h�1C1�FL} st<iff until c.am;
<br /> B}! signing this �.ppli.catioi�, I a�xr.G and u�tdersta.nd that thc C?isErict may �I1tCL' ��lC: �?tOF�e.Yty at re:tso;
<br /> hours to cond�tct an inspeetiort to deterrnine whe:Ehcr thc te.rms of t�ie pi:rmiE 3Yc E.7z.lk"l� rrtet. I fu
<br /> �':,�
<br /> uriderstand tkl��k li i v1018.fL fI1E iziitl5 3Yi� l':OilaL1IJI1: Of �3 J�1Zf'Itilt t�i'tl� LS I$S1-1t.'C� �L�S?� L':�C�1'i rhi� :if%j'il�-�
<br /> the District shall conduct a field inspection of t��e. project pe�• MC-WL7 Rule,J, pr�vided wit�� thi: applie�
<br /> 1 ui�derstand thc L�istrict will chargc fc:es to eover tlle ��et�ial eosts af field inspectiorts, islclur,�in� irivesti;�,
<br /> �_�f the area �ffectcd by the �vork, ana.lysis of tlle woxk, includin�y the services of leg:�i c:oun�e� akld e.n�ir
<br /> :ind at�.y SLi�iSZc�LI{�nt 1Tt{�t�I�OClll� C1f t�lC- W'i7t•k.- The District's actual costs at'c: c�e-emed to be,�Lt1 �C:�I"L11Y1�; �
<br /> the District issu�s noLice ��f thc vic�lati.�n lo tEte permiEEee. I h�avc re_ai� <ind undc:islarid lhe. ML:Vf�} Tec:F-
<br /> Guidelir�es for sar�dt�lan t,_
<br /> /��,�,.._.. -- ---
<br /> 5i;�rtatut�e of propci-ty o � li;Y 1_?:i�C ���
<br /> vn,1n��.1L}-;q1 q,+� C��,...
<br /> ��� y �ao c� ���,�TF;=•,�;-�: �:.,��.�
<br /> Stzbs�ri�ed at�d s��ortt lc� hefor•e ttte t}iis da o _,._� `
<br /> _ .__.,,,, .
<br /> ` + .lAME3 HAROLD SMtTH f ,1 A PJ � � L��p��
<br /> ��}iJg�1C.Aa HNE$0'�A
<br /> Not Public � -- �'��+r�sissanos y_ • 1.
<br /> , � • �� n,.:._ '�r�.. :.... • ''.; I,_.
<br /> � , �`n"J 2e. r /�/a�1�0
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<br /> A roved d Accepted by Date
<br /> ,►atnes Hafner, L7zstrict Tec.hnician
<br /> TOTHL F'.��i
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