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<br /> S.A�DSLAN�T PERMIT �C SANll SUUKt.:� .t..�-n��stj rvxlvi
<br /> �NNEHAHA CRE�K WA'I'��,SHE�.7 DIS'�CT
<br /> . PEa�vu•r�� 9q____—��.:�
<br /> td�le5
<br /> � C�,'U.{G�C. �,r'� •f.�- rc�siding�t �(n 5 �•i�G�� f�/� , �V 0�D, Yl N 5�3�
<br /> � n�� Ciry,statc,zip
<br /> property wncr
<br /> ��f�-�7 S I U F��-��� or PID## C)6 � 117' _ a��/ 01 v i
<br /> Phune Ct�urily � Township,5ecrioty Rttngt (Prom�roperty tax xEafemer►ty
<br /> o�uxl and oceupy the abave sulgle fa.mily residence �nd wish to inst�ll a s���rtdbla�aket on
<br /> M i n.�-e�n bt� 1�o � �n� .
<br /> �.&�:C cE:�IIyr
<br /> � I h3ve cc�ntracted with �a�`�`� �� at ���U ���`�a�� �
<br /> �, ` ^�r cuntrac ar .�ddress _
<br /> C. 1��� 7��Y ��'v �'��"' { , ���� ���� ,� t� install c:lcai� ,<irid from the f�ll�ti�ing suuz ce:
<br /> i:ity,:t�t�.t.iy �hanr
<br /> �1`1� ! � +�iJ1"C�l.�"� P J Par k �� 'i`������-� y �{p�— ���-(]'--� oI':
<br /> supplicr ;�ci�.iress phonc
<br /> �] I wz11 install tSie s�3rtdb�axt�c:t ntyselF 1ro�n t��e followitt� soL�Yc:e• s`=� ��I '
<br /> �r �
<br /> �
<br /> ,�ddress phone
<br /> �p� �p
<br /> If thi,s prc�ject reauires munic�pal approva}��review; please at#�ch doctiment3tion of the m�.rnici �.1 a� rava
<br /> with this applxeation. ��ty shorelxne is�feet and the ciin�.ensions of the proposed ,a�dUla�nl��t �t�^e:
<br /> ��� (LGit�th) � �.�.� {.Widt�t.) � �r�`� (Depth}. Sandk�l.i•rik�t C�IttlC21511�215 et�i121C�# �•2:ceeG1 3
<br /> lertgtlt of 5C�' lc.,r �c7°�� of shoreliz�e},�width of 1(.�' arid�. d.ept�1 of F,".
<br /> 1 LlklC��xSti3YlL� �ll�1.t if t�iis applicatian is �tot completely fil.�ec� ot�t, ox� i# I fail to su�mii tlae required exhibits,.
<br /> the applic��tinn is inc�c�m��le_te atid wi11 }�c returiled. It will not be zeview��i by MCwn st�.ff �xntil coniplite.
<br /> By sigiun� tklis �ippSicafii�n, I a�;ree and ux�derstand t�iat the District �z2ay eittcr tk�e. �roperty at ruasonaUle
<br /> hout�s tc� condu4t ar1 insp4ctioil to dete.rxntne whetk�er #he iex'rns �f tkie per�ttit az'e b�-iri S met. � ftxrthe.z'
<br /> t.tnderst:ind t�1��t if I vi�l�i.fe: tlle terms anci conclitiotts of a ��ermit t11at is i.ysuerl base.d upon lhis a�plicati��t1,
<br /> the �istrict sha11 conduct s� tie�d inspec-ki�,n of thc project �er MCWD �u.le,i, provided wit11 this ap�liG�itiat�.
<br /> I ux►dersta7ld tlle L�istrzct vv'i11 ch�r�e fees to cov�r the actu3.l c:��is of ficld it�spections, it�clu�-�i�i� it�.uest�gatidn
<br /> �f the area affectec� by thc worlc, analysis cf the wot'!�, includin� t�le scrvi�es of 1c�;�i1 c�uxisr:l and en��incers,
<br /> aild siny SEIk7SeC(tl�Clt 1'CL02lItOX'IXL?, OE t�l� W�12'�. TI'1e i^listri�t'S �.ctual �oSts at�e deC2ltea t� be�,�in �Zcert.tiri� whe.n
<br /> tiie DIStT1Ct ISSLL�S X1Lt1(:(: Ot L}:1� VLb�4ltl.vY1 tc� the �ie.rn�i{fe.c;. I have rr�ad atld Liride�'St�ln�� t}Ze MLVJL7 Tec'.hnical.
<br /> ' �dclines r'or satidk�lankcts.
<br /> (� • � • � MlNI�lEI-,Af-[,A CREEK
<br /> � ��M,qTrF�SH�C' ,F�ISTPPCT
<br /> 5i�nahxre of propexty wner Date
<br /> �ubscri�ed �rtc�sworn tt+before ine: this ��clay of �G 1`j� `� . QE� � � 1Q4�?
<br /> ,wnnnti,�n„rmn. � r
<br /> Q s�ryt A. 1..attemer �, :; ; , -;
<br /> -L- �•��i`�.c,�J �►wv aueuc-w�ssarr�► �� ��n �, � . �-�°,r
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<br /> N tary �'ti ;ic: M1p Co�kx�i.�rp�+�as Jan.3t.20op
<br /> •yti�Vyvyyw.n/y�nnnn.^Y,r�nN M
<br /> r��. f7'�cr � /� 9
<br /> Ap raveci and ecepted y n�-t�
<br /> ��It1CS H�lfx1ex,,District Technieian ::a«<it •ns:���s
<br /> TLiTHL F'.�=�1
<br />
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