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?-2001 15�21 MINNEHAHA CREEK WATERSHED 6124710682 P.02i02 <br /> � �. �- `-• �- <br /> .. . , a►33a _, <br /> SA,NDBI.�A�II�'P�RNIIT�&SA1�TD SOURCE . <br /> �BE�'K W�A7�BSHEU DLS'1'RICT - <br /> � . . � T�0 �� <br /> _... , <br /> 1 � ' r � �yt D S�. �w �r„� ss.��,6 <br /> Property Owncr .. Addness Ci�y,Stat¢�Zip -' <br /> >r�'" ,�,''�5�'�- �.�.vi✓+ , or P1D# ��/,(�-� 3 5�3��OD.S' <br /> Piwnc Cotu�ly T�vr�Sd�roey Ra�gc (frwa prvperry tex statc�ucntl <br /> own�nd occupy the ahov�e ain,glc iamily residence and�wislt to irtsialt a sandblatsloct on � <br /> Wce��•y <br /> Minnetonka Portable Qredging <br /> `� I h�.ve contracted with � 500 West Lalte S�t at <br /> / �oefeior, 5533 �� � <br /> - _ to install Glean sa.nd from the foilowirtg sour <br /> city�state�zip phonc <br /> �nt, �l�f44�� e�- �d"�/S __ �A�'I�irc�,G /71 n/. � —��j y/7S r or. <br /> s�p�i�r -- � �ddr�s ptw.0 ' <br /> ❑ I v�nll install the sandblankc�myself f�rom the follo�wing soume_ <br /> supputr <br /> addreas -- � — phono <br /> If this projeet rec{uires muni,ccipal appmvsl or rzview,pleaae attach docutn�entation oE the municipa.l apprc <br /> with this application. My s�oreline is�3o?D feet and�he dimensians of Ehe propose:d sandblanket are: <br /> � (Length) x r.L� (Width) x�� (D�:pthj. Sandblank�:t dimer�sionc earnot exceed a <br /> length of 50' (or S09b of shoreline),a width of I O'and a dcpth of 6". ` <br /> I understand that if this applic�tion is not compl,efely hlled out, or if I fai). to submit the rcc{uir�ed exhik <br /> thc applie�tioa is inovmple�c at1d will be returned..IE w�11 aot bG revicwrd by MCWD staff unti,l compl� <br /> By �it�g t�tais applieation, I ag�e and uitc�et�tattd �t the Diatrict may enter tha property at reasona <br /> hw.rs to ooaduct att inspectiozt to detcraaine whethe� the tcrms c�f the permit are being met. I furt <br /> underst�.n,d.-that if [ violate Fhe ternis•and conditions oI'a permi.t that is issacd base,d upoa this applieati <br /> the Disttiot s�iall.'oonduct a fie1�d i�p�n of tlu ptioje�;t per MC1ND Rule j, pravided with this applicati <br /> i undersfat�d t�ie Disi�iet w�I.charg�c f�cs to�wer the ae�tual oosts vf Geld inspcctions,in�ludir�g investiga� <br /> vf t�i,e are�s�ed by the w�orlc,ansl�sis of the work, ineiu�ding tive mervi le.gal oounsel �nd et�,gine <br /> and any subsequent ntoaibocit�g of the worl� Tl�e Distt�ct's ac[uaE casls at+e���c�.d to be�ii� accruing w: <br /> the District issu.es notice af the violation to the permitte�. i have read and understand the MCWD Techn <br /> G � Ii es f db ts. <br /> . ,. <br /> � � � ��6�0/ <br /> Date <br /> Subs�ri'bed and sworn to befo� me thas �day of �,f�� � 200 � JOa��'�'�' <br /> �C.I�^ � I�TFUYFtIbI1C-M�1NIi�0i� <br /> • �.»..,,.�.� <br /> � <br /> ` , Ily OOnntisson 6�Yee I.a1� <br /> . - � <br /> ary Pablic � ,...,r:,��a�:::.,. � . <br /> - ���... . <br /> Approved and, Acc�pted by Date <br /> �. . . 7t_J�, f\�.� � • T � • • <br /> TOTAL P.02 <br />