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i <br /> � ��� W�� <br /> � <br /> WATER RESOURCE PERMIT APPLICATION—COMBINED JOINT NOTIFICATION FORM <br /> Use this forn�to notify/apply to the Minnehaha Creek Watershed District(MCWD),their engineering consultants,and the DNR of a <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 5539L Keep a copy for your records. <br /> YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. <br /> 1. Property Owner Name(First, Last): Heath Farwell <br /> Mailing Address:5920 maplewood lane Ci�,;minnetonka State:m� Zip: <br /> Email Address:Jfarwell@sbcglobal.net Phone:951.532.9971 p�: <br /> 2. Location of proposed project(Attach map with directions to site): <br /> Project Address:2933 casco point road Cl�,; orono <br /> County:henn Qtr Section(s): Section(s): Township(s): Range(s): <br /> Lot: Block: Subdivision: PID: <br /> 3. Size of site: 37,000 sf Area of disturbance: 17,000 square feet, or acres <br /> Volume of excavation (or fill): 688 cubic yards Length of shoreline affected: � feet <br /> Area of existing impervious surface: 7150 Area of proposed impervious surface: 7341 <br /> 4. Type of permit being applied for(Check all that apply): <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 /> 0 SINGLE FAMILY HOME �MULTI FAMILY RESIDENTIAL HOUSING (apartments,etc. <br /> � COMMERCIAL CONSTRUCTION �INSTITUTIONAI.C't�Nc'rRUCTION(churches,schools, etc.) <br /> � ROAD CONSTRUCTION imber of lots) <br /> 0 UTILITIES ��'���.' I u 'e �, �7�i(�% ms, etc.) <br /> � DREDGING ION(lakescaping,bioengineering) <br /> � OTHER(DESCRIBE): y''�.,� <br /> 6.NPDES/SDS General Stormwate: � , <br /> 7.Alternatives (Describe any other: ,�,, I (/"�"�ri � minimize impacts to water <br /> bodies to achieve the project purpos� �.��"� �N � <br /> � � 1� ��,��� <br /> 8. Project Timeline: Start Date:6.1.� ��+�1-�'�� �I �1 �'/ <br /> il �9. Applicants Representative (Licen� ,�����i � 9 <br /> Business Name:shane homes inc r �J � wal amuth <br /> Business Address:3925 excelsior blvd �y State:mn Z1p.55416 <br /> Email Address: shane@shanehomesi F�; 952.544.0356 <br /> 10.Names and addresses of adjoinin� <br /> Permits have been applied: City_�County ❑ MN Pollution Control Agency�_DNR ❑ COE�_ <br /> Permits have been received: City � County � MN Pollution Control Agency 0 DNR 0 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 project that I must obtain. I understand that proceeding with wark before all required authorizations <br /> are obtained may be subject to Federal, State and/or local administrative,civil and/or criminal penalties. <br /> � �' � �o%R <br /> � <br /> ature of Prope Owner Date <br /> Page 1 of 2 <br />