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JUN-19-2006 14�59 M C W D 952 471 0682 P.03iO3 <br /> Permit �0 , �Z <br /> Sandblanket t�ermit and Sand Source Exhibit Forrn <br /> FAST TRACK PERMIT <br /> MINNEHAHA CREEK WATERSHI=D DISTRICT (MCWD) <br /> 18202 MINNETONKA BLVD. Ph: 952-471-0590 <br /> DEEPHAVEN, MN 55391 Fax: 952-471-0682 <br /> I, reside a�t�/7� ��Cd / � ��" , ��'C��f� <br /> (ProDe ner) (a,ddresa) (City) <br /> , .Q����-��L�2 request approval to install a sandblanket on property described <br /> (State,ZI ) �,(Phope) � <br /> as�" y r) �n,�n..-/ �'J , located in �I�C�v , 'l. <br /> (Street address) �thin the Cily boundaries) (Coun ) <br /> c'�U"ll_7_�3�31-�o��o� _� <br /> (Properly ID#[PfQt�]) (Lake) ( ay) <br /> I have contracted with�Y k�(,.Nr�%9"�Y1C. ,4�� ��To<�l �Q�(l i 0 . <br /> (Nam�of Compeny) (Street eddreea) <br /> Il.f IJJ ��� , (�J�✓11 5,���_,_,_,_..,.to install clean sand frvm the <br /> (City,Stato.Zlp) , (Pho . <br /> following source.�,�._a��-�'1� _— � <br /> (Su�rfier) (Address) ( ,Zlp) <br /> (� �IID/-��C� <br /> (Phone) <br /> I will install the sandblanket from the fnllowing source , <br /> , (Supplier) <br /> , U <br /> 4Add�ss) (City,Ststa,Zip) (Phone) <br /> My shoreline is 1�feet and the dimensions of the proposed sandblanlcet are; �X <br /> (Length) <br /> '� X � Sandblanket dimensions cannot exceed a length of 50' (or 50%of shoreline), <br /> � epi � t . <br /> a width of 10' and a depth of 6". If this project requires municipal approval or review, please attach <br /> documentation of the municipal apprc�val with this application. <br /> 1 understand that if this application is not completely filled out, or if ( fail to submit the required exhibits, the <br /> application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. 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 determine 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 inspection of the project per MCWD Rule J, provided with this application. I understand the <br /> District will charge fees to cover th�? actual costs of field inspections, including investigation of the area <br /> affected by the work, analysis of the work, including the services of legal counsel and engineers, and any <br /> subsequent monitorin9,of the work. Th District's actual costs are deemed to begin aceruing when the District <br /> issues notice of,tk��e:,�"ol tion to. [C��e_.I have read and understand the MCWD Technical Guidelines for <br /> sandblankets- _ ,;—�" 5 �� O� <br /> ature of PropeR er) (Date) � � II�� <br /> Subscribed and sworn to before me un this��day of f.� , � <br /> �� � SHERYL A.LAT1'ERNER ��r' O � 2006 <br /> Notary Public NOTARYPUBI.IC-MINNESOTA <br /> �„ My Commla�lon Explra Jdn.81,2010 <br /> .�: <br /> Approved by: `��~� Date �� �q �� <br /> TOTAL P.03 <br />