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MAR-24-2003 12�54 MINNEHAHA CREEK WATERSHED 6124710682 P.06i12 <br /> ��OMBiNED JOINT NOTIF'YCATION FORM-WAT�R RESOURCE APPLICATIO�i �i <br /> Use rhis:form ta notify/ap�ly to the Minnehaha Greek Watershed Dis�rict (MC'WD),their engineering cmasultants,the <br /> DNR,and the H.ennepin Consorva,tion District of a propnaed waber/wetland project or work which may fa11 with,in their <br /> jurisdictiau.Those a�e�clea shbuld at➢vise you of their jutisdiction or permiC tequirements within 10 days.Fill out this <br /> foim completely and mail a copy,wirh plan,maps,etc..,to the MCWD, 18202 Miz�uetonks Blvd.,Deephaven,IVIN 55391 <br /> Keep a G�p}r for your records, <br /> YOU MUST OBTAIN ALL REQUiRL�U AUTHORIZA'��ONS BEFORE HEGINN]NG WORK. <br /> 1,Applicant' e as�Pi�at,M.L} Phone No, <br /> �"' � <br /> Address(Street,RFD, ox#,City,St�t ,Zip) <br /> C��f-'( �U���1�O��- ��� <br /> 2. Location of proposed project(AtCach diawir�w/direcGons to si ): <br /> COUNT'IC QTR SBCTION(s) SECITON(s) TOWNSHIP(s) RANGE(s) Lo�,Block,Subdivision <br /> PR01'EC7'ADDRESS: 7 G �Q� ` ` C�y. <br /> 3. LENG�H OF SHORE AFFL�CTED(in fec�); VOT.UME OF F�I,L OR EXCAVATION(Cubic yands): <br /> ARBA FII.LED OR EXCAVATED TS A,cres,OR 5quare Feet <br /> 4. '�YPB UF PERM]T BEING APPLTBD FOR: (Check all that apply): <br /> C]STOltMWATER MANAGEMENT PLAN ❑FLOODPJ.AIN AI,TERp?'(ON �WETI,pNIj ALTERATION <br /> DaSH�01�IMPROVEMENT �STORM S�WER OUTFALLS ❑ EXCAVATION(DREDCrCNGj <br /> b.�SA��iqBLANKET �WA DLIFE <br /> �ICE RiD(}E REMOVAL b.d NAVIGATION <br /> c.�RE7'AINING WALL c.�BIUI:NGIlVEERIN'(} <br /> �BRIDGB�c CULVERT CROSS S <br /> OTHER(AESCRIBE) --_ P��5�'�1� �(���� ' <br /> 4a APPL7CAM"S REPRESENTATNE:(Licensed Contracwr,Enginecr,etc...) Jnclud,e nsme,address&phone number. <br /> Lee �r� ' o a �-- <br /> S.PROJE . PURPOSE(why is�is projeet needed-what bene�ts will it pToyide?) , � <br /> � �' � O�- l�lC� d N� � O�CC'�S.S `� M�4 <br /> 6.AL vATNES(describe any er sites or methods that could be used to aciveve i➢�e purpose of}row jcct while avoidmg or ~ <br /> minimi�n���/�y�]gpd impaC , ttach additioaal shaets,if needcd. <br /> 1 v <br /> 7.DATES: Proposed sten of activity: � � � —Q Proposed completion; 1 a--l 3 <br /> dentify an com 1 d worY an attached dravvin <br /> 8. NAME�&ADD1t�SSE�OF ADJQII�IN(}PROPERTY O WI�TERS(Attach list if more) <br /> 9• PERM17'S Ei�►VE B^t��yrRSCBIVED (R)OR APPI.IBD FOR(A)F]tOM: DNTi ARMY CORPS OF ENGk <br /> �;OUNTY CITY MN POI.[,UTION CONTROL AGLNCX <br /> I hereby n ' the recipients of ihis fmm of the project praposed herein aud�eques�I be Rdvised of eny permits or ocher dcroeimina�ioas <br /> conc is projvc�that I rinust in,l undetBtand that proeeeding wirh,work befnro all requi�ed uthori�rions ero obtained msy be <br /> subject cderal,State and/ar a 'nietiative,civi.l aad/or crimina]penalties. / <br /> wre o�Pcrsan Pro os' Pro'ect or A ent � <br /> '"'�. <br />