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JUL-08-2008 09� 11 P.02/02 <br /> p I� �� �� uu `� U <br /> ,II II U :� �008 Permit# ��6 - ��5� <br /> Sandblanket Permit and Sand Source Exhibit Form <br /> FAST TRACK PERMIT <br /> MINNEHAHA CREEK WAT�RSHED DISTRICT (MCWD) <br /> 18202 MINNETONKA BLVD. Ph: 952-471-0590 <br /> DEEPHAVEN, MN 55391 Fax: 952-471-0682 <br /> �,�:H�Q.LES i�-`LE. reside at 2�`3 ��}��1��IL'�C`�(��Yi� , ��4'�I7..��T� <br /> (Propwt Ow�r,er) � (Address) (City) <br /> ��,lv �-v���L (g;�Z} �1�I-'3�ZCJ request approval to install a sandblanket on praperty described <br /> (Stete,Zip) (Ph <br /> as Z,�J'J��c�`�t.Y'�� , located in OQCalA=� , �.�..sQl� <br /> (5lr8eladOfess) (Within the Cily houndaries) (County) <br /> ?�-�1'i-2�5-'SZ•Cx�Z on �-I I I�J�2`,1-1� � i.l i�:� L � <br /> (Property ID#(PID#J) (Lake) (Bay) <br /> I have contracted with����,���lL, , �V�(`,� �Itc'�-�e1 �Sr:l7�a ,�� <br /> (Neme of Company) (Street addrea9) <br /> �I►J[�i��'�I..ItJ �j53��i , �}. t��1 —Zl�t� 4o install clean sand from the <br /> (City,StAte,Zip) (Phon <br /> following source'1�1V�1 Mk . ��'��, �[���)��_ -H�.tMr�u�Y '��i .�'; <br /> {Supp ier) (Address) (Chy,Zlp) <br /> (`��YZ.) �+V�1.2'1�� <br /> c� <br /> I wifl install the sandblanket from the following source , <br /> �Supplier) <br /> � � � <br /> (Address) (Cily,Stete,Zip) (Phone) <br /> � <br /> My shoreline is�feet and the dimensions of the proposed sandblanket a�e: h�0 X <br /> (Length) <br /> �X �� i . Sandblanket dimensions cannot exceed a length of 50' (or 50% of shoreline), <br /> ept idth) <br /> a width of 10' and a depth of 6". If this project requi�es municipal approval or review, please attach <br /> documentation of the municipal app��oval with this application. <br /> I understand that if this application is not completely filled out, or if I fail to submit the r�quired exhibits, the <br /> application is incomplete and will t�e 'returned, lt will not be reviewed by�MCWD staff until camplete. 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 determir�e 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 application, the District shall <br /> conduct a field inspeotion of the project per MCWD Rule J, provided wit4� this application. I understand the <br /> District will charge fees to cover tl�e actual casts of field inspections, including investigation of the area <br /> affected by the work, analysis of tFve work, including the services of legal counsel and engineers, and any <br /> subsequent monitoring of the work. The Distnct's actual costs are deemed to begin accruing when the District <br /> issues notice of the violation to perm ttee. I have read and understand the MCWD Technical Guidelines for <br /> sandblan .n �;� �_ ��,`o� <br /> G/ / <br /> (Signature of Prope►ty Owner) (Dale) <br /> Subscribed and sworn to before me on this �$� day of � , 20 0� . <br /> ✓ ���� � <br /> Not Pu ic SHERYLA. IATTERNER <br /> NOTAIiY WBL1C-MINNESOTA <br /> ' :, IAy Commisslm Explres Jan.31,2010 <br /> Approved by: Oate �� <br /> TnTAi P A� <br />