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` ~ � <br /> Permi � i � �.� � �� � <br /> Sandblanket Permit and Sand Source Exhibit <br /> FAST TRACK PERMIT JUL r 1 2U12 ' <br /> J,� <br /> MINNEHAHA CREEK WATERSHED DISTRICT(MCWD) �y <br /> 18202 MINNETONKA BLVD. Ph: 962-471-0690 <br /> DEEPHAVEN, MN 65391 Fax; 9b2-471-0682 <br /> I,f�An1cY �31�oS resideat 335o FoX S7REE'f , ORo�Jo <br /> (FmpertY Owner) (Address) (Cib� <br /> M(J 55356 , �ia �01 - �g55 request approval to install a sandblanket on property described <br /> (State,Zip) (Phone) <br /> as 5�- , located in O,n�.o , f�y.w. <br /> (3treet eddresa) (Wfthin the Ciry bounderiea} (County) <br /> 05-��� -�3y'i o008 on �f'�l�ka- � 1'1AXWC�4V <br /> (Property ID*[PIDfI]) (Leke) (Bay) <br /> I have contracted with e0����S����Q <br /> Ll►1 <br /> (Nameotcompeny) �OUND,MN 55��6`4 (sfreeteddress) <br /> ,(� to install clean sand from the <br /> (City,Stete,2ip) (Phone) <br /> following source �cYl�,�a.�. Sa�.a , ��,,,,�k,,.. <br /> (SuPPlfer) (Ad�hesa) (Clty,21P) <br /> (9�a) yy8 - y1�5 <br /> (Phone) <br /> wili instal e sandblan rom the follo urce , <br /> (Suppl r) <br /> Wdd►ess) � (Cfty,State,21p) � � (Phone) <br /> My shoreline is S�+ feet and the dimensions of the proposed sandblanket are: 50� X <br /> (Lengih) <br /> �+� X lo� . Sandblanket dimensions cannot exceed a length of 50' (or 50%of shoreline), <br /> aPt � , <br /> a width of 10' and a depth of 6". If this project requires municipal approval or review, please attach <br /> documentation of the municipal approval with thls application. <br /> I understand that if this application is not completely fllled out, or if I fail to submit ihe required exhibits, the <br /> application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. By <br /> signing this appllcatfon, I agree and understand that the District may enter the property at reasonable hours <br /> to conduct an inspection to determine whether the terms of the permit are being met. 1 further understand that <br /> if 1 violate the terms and conditions of the permit that is issued based upon this application, the District shall <br /> conduct a field inspection of the project per MCWD Rule J, provided with this application. I understand the <br /> District will charge fees to cover the actual costs of field inspections, including investigation of the area <br /> affected by the work, analysis of the work, including the services of legal ooungel and engineers, and any <br /> subsequent monitoring of the work.The District's actual costs are deemed to begin acc�uing when the District <br /> issues notice o t viol io t permittee. 1 have read and understand the MCWD Technical Guidelines for <br /> sandbl �ke . � `d � <br /> (Signature of Pro er) (Date) . <br /> Subscribed and sworn to before me on this day of ,20 <br /> Notary Public <br /> Approved by: �'�'�✓`^— ��-�-- Date 8 Z ��. <br />