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L�E� : �'-1'�'�'�+ 1�'�GZ�i f l I IdllEHHHi=� i_F'EEI I,.IHTEF"=�HEL:� r�1�-��1�=1�=�� F'.�=�1.'�=�1 <br /> St�N�7Br,AN�T P�RMIT & SAND SOLIRGE ��T�Z'I' �'��M <br /> MIZViVEI�AHA CKEEK '►�VATERSHED ].7ISTKTGT <br /> _ PE�T 9� � `�`t-24E. <br /> I,�aY'�t 1�17�C��{°� residi�l� at �'� �,� � . �.0.k t ��" , 0 5��'� �� <br /> FroExrty Owtier Address City,State,7.ip <br /> �_�� ��a.4 3 i��.v� , or �'I�#�.5 11J1 �� �� o o W`f <br /> �hOne Lounh� Township,Secttian,�an;,e ((c�m prv�perty tax st�temcnk) <br /> oti�n ar�d occupy the abo�re sizic;le family residence az�d w-is�l to iiis��ll �.sF�ndblanket or� <br /> M����t �rt"�P.��� <br /> Iake&Say - ----- <br /> � I �ave contrAe�ed �rvith ��N�CEPT LANDS .APIN , At <br /> —��r�t�i�l�ST LAt�l� nd�irrss <br /> MOUND, MN 55;�64 fo insi�ill clr.�,n �i.nd ironi iitc: following saurce_ <br /> c:iry,statc,�ip phonc � <br /> .�--��=�+� '`J 4.r`x� �.:t1�� , ��g �� �� � � or: <br /> 5 Ll��lLlC2' A S�ICS$ �7}IOriC <br /> ❑ I �vill install tlle sandbl�nket myself from t]ie followin�l� SC71IY'C:C. � <br /> - sup�lier <br /> -- --- - � - <br /> address phottc. <br /> If this project requir�s tnunicipal �pproval or revie���, pleAse attach doctintientatio�i of the munic�iphl �ipproval <br /> with this applicatiori. 11�y slioz�eline is `�� feet ��nd tl�e di�n�:ttsians of the �,r�,p�,sed .s�ir:idblanket are� <br /> �7 1��� (Lcn�-E�rt) �c �Q__ (Width) :� � (Deptl�). Saildblanket dime�Isionw car�nc�t excee�l a <br /> 3en��th of 5�i' (oz• �D�% of shc�,�linej,�, width oi� 1�' and � dupth of 6". <br /> I ix�ic�ct�stanc� that it� tlus application is r�ot complete�y fi��ed aut, or iZ I f3i1 to submit the required ex�tibifs, <br /> thr ap�alic�tiot� is ixicottiplefe axid will be returi�ed. lt w'ill iiot L�e review'ed }�}' MC�VVL? staff tiiltil ��om��lt:t4:. <br /> ]3y 51�211Y1� t�'l1S ap�licatioii, � :��rc�e. �nd understand that the 'L�istrict ni��y cnt�:r t��t: pmperty ��E r���a�c�n���>lc� <br /> l�ours #o conduc:t an ittspr.ction to detcrtninc whekher tllc #erms af the. p�i•mit are �7ein� meE. I furtiler• <br /> ur�derst��r�ci t��at if I violakc the fertn.s and cot�ditions of a ��erinik thaf is issucci baseci uport this a��plicatiofz, <br /> t�t� Dlsttict sltall cotldLict a �ie.ld ir�spectiott o� t}�e pr��je.ct pez' aVICV�D Rule i, ��rrnrided ��-�111 tl,;� af�plic�t���+tt. <br /> I undersfarid t}ie: L�is`trict wil� �.har�c fces to c�ovcr tl��. a�tu:�l ��osts o# ficld ins�e�tions, inc:liadinh inv��tis�F�ki�n <br /> of the are� affeete.d by thc w��rk, analysis of khc wc�rk, inclrxc�in�; the sc.rviees ot' le��al coun.5e1 a}ld c:n��irtce:t•s, <br /> tin�� ��ny suE�si: c:rtt tnonito����t� of the work. Tltt Distri�k's �ctual cosfs �rc dc=czi�ed to bc�in ac:��ruizi� w�ic-n <br /> thc: Di�tri'� � _ es rtotiee �f tltG vic�latiotl to the �>ertttit�ec. I h<�v�' re.�d <�r�d �and�:r�;tand tl�c M�'1�rU '1'i�c•�1r1i��a1 <br /> �ui`c �' i�T .)al1c��?�clzlkct�. � <br /> � �� � � <br /> -'_,� '� � �. l L/ � � <br /> Si�rtatut�c of propczty o��rnc Dafe <br /> �� <br /> Sut�sc.ribed .and sworti to be.fo�,c zne thi� /''� �- �y of L�. a.c�-�1�� `� <br /> ■ r <br /> F � � ^. � JAM�S HARaLD SMITN r,: h ��e . - _� <br /> � ;,,,;,_ <br /> / r�arnav Pueuc-aurn�sar� � <br /> ��7�'-� / ������ rar c.o►�nss+o�a�xai�s�.�apoa � � <br /> t�lc�tar_ r�u.}aliL . . „ <br /> �IL: % a` <br /> ; - �':� <br /> `�"` /7 �� " � ------- � <br /> 1l� .rovc� and I�c�ce��ted by L�atc� � � <br /> .)atncs Hafnc-r, L�istrict Technic:iarl ::3ndl`-`nt�r�a�; �_ _ ._ <br /> TOTHL F'.�-�1 <br />