2016-01007 - demo - Laserfiche WebLink

Home Browse Search

�_ , . , rm R �� � �u �� 2o�s WATER RESOURCE P�RMIT APPLICATION ORM Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD)of a propo ro�ect or work which may fall withi their jurisdiction.Fill out this form completely and submit with your site plan, ��cta tathe MCyV_D at; 15320 Minnetonka Blvd.Minnetonka,MN 55345. �------ Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHOWZATIONS BEFORE BEGINNING WORK. 1. Name of each property owner: Peter Santrach Mailing Address: 222 Hennipen Ave S#407 C�ty; Minneapolis State: MN Zlp; 55401 Email Address: Phone: 651-303-3810 Fax: 2. Property Owner Representative Information (not required) (licensed contractor, architect, engineer, etc...) Business Name: Dirt Devils Services, LLC Representative Name: �ared Stotts Business Address: 6447 Sunset Trail C�tY: Loretto State: MN Zip; 55357 Email Address: dirtdevilsservices@yahoo.com Phone: 612-366-4876 Fax:�63-498-7825 3. Project Address: 1700 Bohns Point RD City: Orno State: MN Zip: 55391 Qtr Section(s): Section(s): Township(s): Range(s): Lot: Block: Subdivision: pID; 1611723220003 4. Size of project parcel (square feet or acres): •63 acres 27,249 sq ft Ac•ea of disturbance (syuare feet): •4 acres Volume of excavation/fill (cubic yards):100 Area of existing impervious surface: Area of proposed impervious surface: Length of shoreline affected (feet): Waterbody (&bay if applicable): 5. Type of permit being applied for(Check all that apply): � EROSION CONTROL ❑ WATERBODY CROSSINGS/STRUCTURES ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANAGEMENT O WETLAND PROTECTION ❑ APPROPRIATIONS ❑ DREDGING ❑ ILLICIT DISCHARGE ❑ SHORELINE/STREAMBANK STABILIZATION 6. Project purpose(Check all that apply): ❑ SINGLE FAMILY HOME � MULTI FAMILY RESIDENTIAL(apartments) ❑ ROAD CONSTRUCTION � COMMERCIAL or INSTITUTIONAL ❑ UTiI.,ITIES ❑ SUBDIVISIONS (include number of lots) ❑ DREDGING ❑ LANDSCAPING(pools,berms,etc.) ❑ SHORELINE/STREAMBANK STABILIZATION � OTHER(DESCRIBE): ;�-�� i'. t ,,„ 7.NPDES/SDS General Stormwater Permit Number(if applicable): 8. Waterbody receiving runoff from site:Lake Minnetonka 9. Project Timeline: Start Date: ASAP Completion Date:8/31/2016 Permits have been applied for: City, ❑County �MN Pollution Control Agency �DNR �COE ❑ Permits have been received: City—�County�MN Pollution Control Agency—�DNR�COE—� By signing below,I hereby request a permit to authorize the activities described herein. I certify that I am familiar with MCWD Rules and that the proposed activity will be conducted in compliance with these Rules.I am familiar with the information contained in this application and,to the best of my knowledge and belief,all information is t�•ue,complete and accurate. I understand that proceeding with work before all required authorizations are obtained may be subject to federal,state and/or local adr�i trative,civ �dfe;criminal penalties. �� --� 's�� _��— � Signature of Each Property Owner Date i<c�� i�.,�rl i,�I_�.�i_ ��:�.:��_� 1 t�t� i