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. ti. <br /> Q � � � � U► � <br /> AUG � 7 2010 <br /> P�rmit # 1D - 'Z 5 � <br /> ��iL)REl�1N� �ROSjON PROT�CT��N - F�►,ST TRACK PERNl1T <br /> 1NI11�INEHAMA GR��K VII�T�RS�-lED �1S�'R1CT' �MCWD) <br /> ���t�2 11�ir�netonka Blvd. <br /> #��ephavex�, MN �v3�'1 Ph: 952-471-0590 <br /> Fax: 952-47'1-0682 <br /> 1. 3�t�l�i�L���.751e�c�to+r re�id�a# 33:�0 1 0'� `���.rt <br /> (Property Qwne�) (Street Address) <br /> �n.crc�a (''1�— S535b , ysZ y-t � �-S'loa request approvaltq install ripr�p <br /> ___ � <br /> (City3 -(Sia#�) (z�P) �phone) <br /> sfi�r�relin� �ros}on prot�etion on prop��y described as 5 a�-•.� , located in <br /> (Street address} <br /> �_�-►� � • > C� -.1�-�- �.� ���{.. Qoo 3 . The riprap irrstaliatifln <br /> (V1�thin tt�e Ciry bound�ries) � (Gnunty) (Property��D# [PIB#]) <br /> �ril1 cansist ofi �o along the sfi�oreain� of ��n1��c�. YYlo�cvJl;� in full <br /> jLineal feet) (Lake) (Bay) <br /> �eca�da�ce wat}� t#�� tll��r��e�aha C��ek Wat�rsh�d District Shore)ine Protection Guideline fior <br /> ripr�a�placement required for issuance ofi a Fast Track Generai Permit. 1 have contracted with <br /> �ONCEPT LAPjQS�APIN� � �_� <br /> 3jk��if'� I� ny) (5treet address) . (Ciry) (Zipj (Phane) <br /> MOUND,MN 55� <br /> ���',�.c, ; �to �erfiorm th�work vvho is�amiliar wi�h the technicai <br /> (BQnd Numbar) <br /> r�uir��n�nts and h�s fi�,�Jf 1�ed�}�� bot�ding requirements of the waters�ed di�tri�t(s�� page <br /> tv►rc�), 1 h�v�rc�d �nd und�r��nc�#1�e requirem�r�ts of the M�V�ID �elating to Shareline Erosion <br /> �r t���ion. � / <br /> I� �,� � '� (� <br /> _ { �ature r.�� riy Owrier3 _ _ (Da�) <br /> �ub 'b�d and �wom tfl befiore m€�on this �"1�`�= day of K;� _ 20� <br /> . <br /> • � 4 Notiry PuWic <br /> Notary I'ublie Mlnn�:ou <br /> IM�r Comm.Expka <br /> 01 <br /> � �3 (� <br /> �►pp�ov�d bY: _ Date ' <br /> t�f�tn`bution: �'roper�y Owner �,CoTifi"�ctor �Municipa.i"�y �DNR _Disfict File <br /> f�age 1 ofi 2 <br />