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' Print Form WATER RESOURCE PERMIT APPLICATION FORM Use this form to notify/apply to the Minnehaha Creek Watershed District(MCWD)of a proposed project or work which may fall within their jurisdiction.Fill out this form completely and submit with your site plan,maps,etc.to the MCWD at: 15320 Minnetonka Blvd. Minnetonka,MN 55345. Keep a copy for your records. YOU MUST OBTAIN ALL REQUIRED AUTHORIZATIONS BEFORE BEGINNING WORK. 1. Name of each property owner: Bob and Jennifer Eaton Mailing Address: 945 Forest Arms�ane City: Orono State: MN Zip: Email Address: Phone: Fax: 2. Property Owner Representative Information (not required) (licensed contractor, architect, engineer, etc...) Business Name: M & M Homes Contractors Inc Representative Name: Mike Fritz Business Address: PO Box 90 City: Cologne State: MN Zip: 55322 Email Address: mfritz@mandmquality.com Phone: 612-554-2556 Fax: 3. Project Address: 945 Forest Arms Lane City: Orono State: MN Zip: Qtr Section(s): Section(s): Township(s): Range(s): _ Lot: :�, Block: ��, Subdivision < <"�„��`s+ �r�)�_�, ( �_ ,, ,��l�.� � I��_,�4BID: '� 1 i j � -, � �.-. r � ' +. 4. Size of project parcel (square feet or acres): y ; t�_� � . i t --— --�-- Area of disturbance(square feet): ". � .; ', c� Volu�lle`'of excavation/fill (cubic yards): 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 ❑ 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 O UTILITIES ❑ SUBDIVISIONS (include nuinber of lots) ❑ DREDGING ❑ LANDSCAPING(pools,berms, etc.) ❑ SHORELINE/STREAMBANK STABILIZATION ❑ OTHER(DESCRIBE): 7. NPDES/SDS General Stormwater Permit Number(if applicable): 8. Waterbody receiving runoff from site: 9. Project Timeline: Start Date: � =`, �� ! '=_> Completion Date: '�4 , � � 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 ain familiar with the information contained in this application and,to the best of my knowtedge and belief;all information is true,complete and accurate. I understand that proceeding with work before all required authorizatio a�e obtained may be subject to federal,state and/or local admirristrative_c�y.�i'_,au�/or criminal penalties. � ;� �� f � ri { ;.' i f„�, ,J/J�,"""""'"'2r;"=;.cr , ` ' , r ' .�. *�. _. . , . . . . . r . . Sfgnature of Each Property Owner � Date � �!;V;';�,<� / I`,/l i ..,.