Laserfiche WebLink
. . _ ,�._..�.`_�e.__ '-. � -. _ . . � . _ - -- - �,.� _ - - - - - — ' --' <br /> � .._. _ .. .�r _:, ._ _ ___. ..�=._ , �. � .:_ . � _ _ <br /> .. . _ _. := _.-.,�v--'-... _..-�-=__f_ .._. _.. .. .F-: .. i ��` _ — _— _ - —— - � ". - - --- —= <br /> - -� - -- � ==_ ---=---__.-- . . :--_ _ _�� _:_— _ _: . -_—PC;ExhibitH_� �� <br /> • WATER RESOURCE PERMIT APPLICATION—COMBINED JOINT NOTIFICATION FORM <br /> Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD),their engineering consultants,and the DNR ofa <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 55391.Keep a copy for your records. � � <br /> •YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. <br /> • 1.Property OwnerName(First,Last):�THERINE M FOX TRUSTEE $i I 1 Fo fl , Tr us � - <br /> Mailing Address:1095 FERNDALE ROAD W� Ci�;;WAYZATA , State:MN ZiP.55391 • <br /> Email Address:�(ll� Phone: " y�r/� Fax: ►�/q � <br /> 2.Location ofproposed project(Attach map with directions to site): <br /> 1095 FERNDALE ROAD W - ' ORONO `--- �--'- �- -" - `- - -- <br /> Project Address: " City: <br /> County:HENNEPIN Qtr Section(s): Section(s): Township(s): Range(s): <br /> Lot: Block: Subdivision:see attached description pID:02-117-23-43-0023 <br /> � 3. Size of site:55,410 sf � Area of disturbance: 2Q�Gi(� square feet,or acres <br /> , Volume ofexcavation(or fill):2��cubic yards Length ofshoreline affected: NONE feet. <br /> Area of existing impervious surface:9.628 sf Area of�proposed impervious surface: 9,294 sf <br /> 4.Type ofpermit being applied for(Check all that apply): � <br /> 0 EROSION CONTROL ❑WETLAND ALTER.ATION <br /> ❑ STORMWATER MANAGEMENT ❑WATERBODY CROSSING ' - <br /> x❑ FLOODPLAIN ALTERATION �SHORELINE/STREAMBANK IMPROVEMENTS -- <br /> ❑ DREDGING <br /> 0 OTHER(DESCR�BE): � <br /> 5.Project Purpose(Check all that apply): <br /> • � SINGLE FAMILY HOME ❑MULTI FAMILY RESIDENTIAL HOUSING(apartments,etc. <br /> ❑ COMMERCIAL CONSTRUCTION �INSTITUTIONAL CONSTRUCTION(churches,schools,etc.) <br /> ❑ ROAD CONSTRUCTION �SUBDNISIONS (include number of lots) <br /> ❑ UTILITIES �LANDSCAPING(pools,berms,etc.) <br /> ❑ DREDGING " ❑SHORELINE STABILIZATION(lakescaping,bioengineering) <br /> ❑ OTHER(DESCRIBE): � <br /> 6.NPDES/SDS General Stormwater Permit number(if applicable): N/A <br /> 7.Altematives(Describe any other sites or methods that could be used to avoid or minimize impacts to water <br /> .bodies to achieve the groject purposed.Attach additional sheet if needed.) ,. <br /> . ;.NfA � <br /> 8.Project Timeline: Start Date:TO BE DETERMINED Completion Date:TO BE DETERMINED <br /> 9.Applicants Representative(Licensed contractor,engineer, etc...) <br /> Business Name:BRUCE W. SCHMITT&ASSOCIATES Representative Name:BRUCE W. SCHMITT <br /> Business Address;320 MANITOBA AVE. SOUTH Ci�,:WAYZATA State:MN Zip;55391 <br /> Email Address:bschmitt@brucewschmitt.com Phone:952-476-6222 F�.952-476-6228 <br /> 10.Names and addresses of adjoining property owners(Attach list if necessary): <br /> ���r-�n�-++���sT � � <br /> : __ - Permits have been applied: City�_County ❑ MN Pollution Control Agency_[L DNR�COE_[L - <br /> Permits have been received:City ❑ County ❑ MN Pollurion Control Agency ❑ DNR ❑ 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 conceming this project that I must obtain. I understand that proceeding with work before all required authorizations <br /> are obtained may be subject to Federal,State and/or local administrative,civil and/or criminal penalties. <br /> �� <br /> %� � I .��� sj� 5�U 7 <br /> . Signature ofProperty wner Date � <br /> Page 1 of 2 . <br />