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SEP-09-2008 14�35 P.02i02 <br /> Permit# � b -2� <br /> Sandblanket Permit and Sand Source �xhibit Form <br /> FAST TRACK PERMIT <br /> MINNEHAHA CREEK WATERSHED DISTRICT(MCWD) <br /> 18202 MINNETONKA BLVD. Ph: 952-471-0590 <br /> DEEPHAVEN, MN 55391 Fax: 952-471-0682 <br /> I, 1�IiC11AGl I�q�' reside at 3�bS �i'"ec�cfi d� �,��' , �YD�►c7 <br /> (Propertv�Owner)�� � (Addreaa) (Cily) <br /> 1�N S53 , S 755-�o request approval to install a sandbianket on property described <br /> (S1ate,Zlp) (Phone) <br /> as �S___I�S�T�c�crt k. c'F , Ivcated in 0�(U�10 , ' ,_,__ <br /> (Streel addrass) I� (Within the City boundaries) (Co nly) <br /> ��-�1��—2 3-I Z-ool bon -IF �.- , <br /> (P�operty ID l�[PIDR]) (Lake) (Bay) <br /> L'�d'I have contracted with �� ��v , 7�QY �� � �.. <br /> (Namc of Conlpany) ($lreet address) <br /> Snl��S ,�vh l�'w ss�Y_, �61�. } 6� - oz�S to instafl clean sand from the <br /> {Ciry,Stato, ) ^ (Phone) <br /> following source 4.� lle� Sw'�1.� G��- s�� � �a.h�� �°'� C�'`a- 5�3�8 <br /> (Supplier) (Address) (City,T.ip) <br /> rys� ) �1N8 -`l175 <br /> (Phone) <br /> ❑ I will install the sandblanket from�he following saurce � � ���o <br /> (SuppGer) ' <br /> �(6�Y w�-�t.k+/�, �p��� �/4 /�w 5,5�3Y , (6���.) G��- ouf a <br /> (Address) (City,Sta1e,Zp) (Phone) <br /> My shoreline is 10 o f�et�nd the dimensions of the proposed sandblanket ara: �U X <br /> �A � (Lenglh) <br /> '3�_X��San lanket dimensions cannot exceed a length of 50' (or 50°10 of shoreline), <br /> (Depth) (Wldth) <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 appraval with this application. <br /> I understand that if this application i:� not completely filled out, or if I fail to submit the requi�ed exhibits, the <br /> applicatfon is lncomplete and will b� returned. It will not be reviewed by MCWD stafF until complete. By <br /> signing this application, I agree and understand that the District may enter the properry at reasonable hours <br /> to conduct an inspection to determine whether the te�ms of the permit are being met. I further unde�stand that <br /> if I violate the terms and conditions uf the permft that is issued based upon this application, tha District shall <br /> conduct a field inspection of the project per MCWD Rule J, provided with this application. I understand the <br /> District wfll charge fees to cover the actual costs of field inspeetlons, including investigation of the a�ea <br /> affected by the work, analysis of tho work, including the services of legal counsel and enginesrs, and any <br /> subsequent monitoring of the woric.Th DistricYs actual costs are dsemed to begin accruing when the Distrlct <br /> issues notice of the violation to p ittoe. I have read and unde�stand the C Technical Guidelines for <br /> sandblankets. � O p <br /> a <br /> (Signature of Prope n D te) � <br /> Subscribed and s or to o�e e on this�_day of Y , 20 C� . <br /> Notary u ic ASNLEY IR�ENE I,INDANL <br /> NOTARY pUB�IC-MINNESOTA <br /> p��� �,,�I � Y� '1��, ' �'.�, oata '� '��� <br /> SFP n 9 �nnR <br />