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<br /> ` Print forrr�
<br /> ��.4TER REtiOC'R(:'E PER�I[T :�f'PL1C:aTiO\ F'OR�1
<br /> I'<r ih;,t�n•i;�: tu nC�tity�nP(�i� tu l:u Minnci�af a(�rick 1�'�'stershe�l I)�;trict�1�11_���.��)j<<f:+ pr��;��;u: F,r,,ie�t ur w�rk���hi;:ii i,ia�.� fizil �,.��thui
<br /> tl��ii j��ris�ict�;u�t. Fili i�u? tltis ftxm COttt�7lctcly etld submi! w ith�t�ur iitc pian. rr.<i�r,. cEc. Ic;th; MC'N D:t:
<br /> 1�3_'i1!�liiinetonka Bivu. :�-linnet�nl;a, 1-1N 55�45.
<br /> I�e�p a r�,p` ?br y�,ui rrrc,rds.
<br /> YOU 1�I�S7� OBT;'�l� AI_.l_ REQLI[Rf��C) nCiTHUR17,ATlONS t�LFORL BEGIV�\fNG ti�ORK.
<br /> ;. Narnt �3f eacli �rupet�ty o���ner: - � '
<br /> -- - _--
<br /> 1�lailini :�ddress: q(� �� � _; _ � ' ' ' �� ^ �,
<br /> -- e� �L�_���----- L L _ C it�: � l � �, i� State: �_ <� 7�p � °;;
<br /> Email Address: Phone: Far: � -----�--
<br /> '. Pr��per1�- O���ner Keprc,e»taiiv� Inturmati��n (�1ot r�t�uiredi (license� eontr��etur. architeci, engineer, ete...�)
<br /> B�i�,nzss Name: _,,,'�_�{_y_�V_�_.✓._.���s�_L►� �.-� Reprz�entati�e Vame: _L_�c�
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<br /> f3t�5�nr,s Addre�s: I I C.3�'L-�,1 m o n�- !�'v�-lv'�- --- C�t r: �Gl.✓IL�Vc v` S ate: '�v1 ZiE�. �,S� 1
<br /> Emaif .Adc�ress: _1Y1���_' ��f��.v.f_.�__���'-�---- f'13or,e: �la���_�`�'_� f�ax:1��_.Y_�y-J��
<br /> 3. Projert .A�idress: _- t�, VJ Cih�: Y� ,? �:
<br /> State: �y� _7_i�,: 55� �_Qtr Seetion(s}; . --- Section(s): To��nship(s): __ Range(s): ��
<br /> L.�t: _ Block: Subtiivrsi�;n: 1'iD: —
<br /> �. Slze of pruject parcel (syuare tcet �r acres}: _:� S Lt(' r�t S
<br /> __� --
<br /> Area of disturbance (square t�et): � � L'C'C ' _-` Volume of ex:;a���ation%fiill (cubic yards?:___S�.Y=_'-_--__--
<br /> Area of�xistin� imperviou; surfa��e: _ :qrea of pro�used imp�r�iuus surta�e:
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<br /> I.ertgth ofshoreiinc affectcd (tieet)' VVaterbody (& bay it appli�ab(e): ---- ----
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<br /> ti. �Typc c�i pern�it beiug applied for(Ch�ck all that apply):
<br /> �,, F�ROS1Uh Ct)'�TROL �-� WATEKBUUY C'ROSSINGS!STRUCTURI:�
<br /> i��� F��UODPL,AIN .Al.l'ERATIUN .� S'IOKM�ti'ATf;R MANAGF.-.�1ENl�
<br /> [� �'E"T'L�1NU PRO7'EC'l i�)\ :^ APPROPRIA7�1ONS
<br /> .-' I)iZE�DG1Nti :�' ILLICI�(� OISCI��.�h��E
<br /> �-_ SHOR�:LI\1�,STRI:A'�1BAtiK STABILIZ.�TEON
<br /> b. Pro�ect purpose (t'heck ati that apply):
<br /> f�'i SiNGLE FAMILY IiOME �� �1l!L.�i�l r�,�!�1ELl' RES[llLti�TIAL (apart�nents)
<br /> ❑ RUAD CONSTRUCTIO:� ❑ COMI�IERCL�iL or I'��ST(Tl,'TIONAL
<br /> i� UT1L["I7ES � S(_�F3DI��15tONS (include number oE�lots)
<br /> .- t�tu.nc;l�c� ;� t..��r�sc.a�r�c„po„i,. re,,,,,. �rc.�
<br /> .- SNi)Ri�l.!\EiSTRE.Ah1BA?�K S"T�ABIL(IA�TIC_�N �� C)THER IDESCR;I3G): ��4�bt t') i �1�V1
<br /> %. I�P1)ES;'SDS (ienerai Stormw�at�r Per��tit '`�lumber-(ifapplicable):
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<br /> ?�. bl�aterbody receiti�ing runoff frt�m site: �. �;, !�i '-' •>i t-t� t�r' r. -
<br /> 9. Prujrct Tii�ieline: Start Date: �- ► - j � _ Cumpletion Date: �% - � � �
<br /> P�rmit. ha��e bcen applied for�: C'ity--_�Cui.ii�t}� ❑ ��[V Polluti�n C'��ntroC A�enc��__�DNK ❑C'OF ❑
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<br /> Pcnnit. have been recri�eel: Cit� --�C o;int� ❑ �TN Pollution Conu�ol Agencv -❑I)NR---�CO(:--�
<br /> I�y signin�below. I h�reiiy request a peimit ti�uuthonie the arti�ities de>cribe.i h�reii�. t ce��tifv ihai I am lamiliar witYi '�1CVe'D
<br /> Rules and that [he proposed�ictivity will be conducted in compliance w�ith rhese Rules. 1 a�u familiar w�ith the int��rrriation
<br /> contained in this arplication and. to the besi of my kn���vledge and beiiet: all inti>i�nation is true.complete and a�curate. I
<br /> i�nderstand tt�at pr�x•ecdine«��th �,���rk bet�rre all .-�yuired authoriia�ions are��htained inay br,ubject to ted�rat, state and!or local
<br /> ���i;y�i�iistrative,civil a��ur crimi ai pertaities.
<br /> r 1, �' '�-..') ) "� .�., 2 � — ------- -- ,t ��i ._� --
<br /> tii,�i;at� re�7f Taeh .� �em�Ow�ner T).:�-t
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