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AUG-16-2001 10�37 MINNEHAHA CREEK WATERSHED 6124710682 P.02iO3
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<br /> SANDBL�'P�t11�1'r`J�S+l��iD SOURCE �IIBI'� FORM
<br /> c�w�a nrsr�tcr �
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<br /> 1, .[� CG c ' 'tog at � ,�--G►�,q-yz.or.¢ 17'I�v. S'S�/
<br /> PI'agelfy OM►ncr . Addleea City,5tele,Zip
<br /> q� ���-.�ssfS" ��,�n! o��u#�l�- �i� -..�� .a�av��
<br /> P1wne camdy °li�dap�ebr�lia..�ge Via�psope�ry ta:awe�nd�d
<br /> own aad 000upy the abo�e�gle�snily�deaoe atid v�►is�to instnLf s s�t�dbl�nket an
<br /> /�j 7,r%; � � A.,��,f�1,. MInnE�tonka Portable Dredging
<br /> ��a�r • 500 W�st l.ake St.
<br /> � � ��� ����� �xxcelsior, tV1N 55391
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<br /> . �-�,y=9s�S� to instalJ clean sand from klte t`ollowir�g souti
<br /> �.�.� P�'�
<br /> (�in . /)9,i�.�.�� 5�,� �,�,A Rac,�°r /77 N , 'i`'y�—�/75— or:
<br /> .e�a
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<br /> p � �`�.n�tau th���Cr m�1f ttv� r�e[dlowing sourcc_ p
<br /> suppllor
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<br /> �ddrta� Phonc
<br /> if this project s+equi:es mu�oipaj apptvval or�+cview,plle�e attach daoucnentaEiun of thc municipa�! appn
<br /> with ehis application. My alw�line ia �.�� foet and the dimc�sians of rhe propo�ed san�blanlcet are:
<br /> T.�,(Lc�gth) x � (W'�dth) x__� (Dept�,Sandblsnk�t dimer,sions cani�o� excecd a
<br /> length of 30' (or 5046 of slvoc+clivao),�width of l0'and a dc�pt�of 6".
<br /> I underslar�d t�st if ehia applioatao�n es not oompl,e�c�y ;ml,ed aut,or if Y fAil to submit th� requirod exhil
<br /> tha app}iadiaai is ineorRplr,�e and wi9l be Rlurned, it �will nut be nviewed by MCWD stafF until cotnp:
<br /> �Y ��48 � �PP� I a,gtoc and w�t�d that thc District caxy r.x�ter thc property at r�a�on;
<br /> h�our� �o couduct �n in�peotiam ta determiae w#�etl�cr the �erms vf the permit are bcir�g mct. I fun
<br /> undesstand-that if i v[olate the tetms�and copditioris of a permit lhat is issued br�scd upon this applicat
<br /> ehe�i�te�ot sholl`conduet a ftc]d i�peetio�n of rhe p�o9eer per MCWD �,ulc,j� pnwedod with rhis applica►
<br /> i u�nd L'h�e Dis�riet•s�!chagc�ta ov�t thc��uurl c�oats af P��' � ns,incly►dir�g invcst�ga
<br /> of the at�ea Rffecrtr,d by the virtuk,ae�e►lysis of tlu wark, ia�iv�di�g the ` I�g:l cou,nsel $n,d crr,g:ne
<br /> aad az�y su6ae,quent ee�onibariqg of the wurk The pisfr�'s�etval � ar+e de ' ta bcg,��.�cn�.ing w
<br /> the Dieteict issue9 nrotiae of!he vivlati�en to the per�itt�oc. 1 have rtad and underst�uYt�i��llfi�V�[D Techr
<br /> ideli,ncs for sar�db ts.
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<br /> �aEure of prope.tty v�+�+ner Date
<br /> Subsaribed ae�,d sworn to beEo�e m�this �day of, P � 200�;
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<br /> ' � ,t�n E Noo.,
<br /> N Ptiblic � . .��:; . �y"�+�Aa�n_��
<br /> . �y��v°�•b �DO
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<br /> Appeoved and Ncaelxed by Date
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