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OCT-08-2003 13�06 MINNEHAHA CREEK WATERSHED 6124710682 P.93iO4 <br /> Q�'�0 J <br /> COMBINED JOINT NOTiFICATION FORM-WATER RESOURCE APPLICATION � <br /> Use this form ta noti�y/apply to t�e Mirneehaha Cre�k Watetshad Distiict (MCWD�their engineering oonsultat�,the <br /> DNIt,and che H�au,c�an Co�nservatian D�saicc of a proposed waoerhvetland p�oject uz w�lc which may faII wirhm meir <br /> jurisdicrion.These�ge,ncies should advise you of their,jurisdic6on or pesmit�withia 10 days.Fill out ti�is <br /> fann completely and mail a oapy,with plan,msps,etc...w thc MCWA, 18202 M.innetvnka Blvd.Deephaven.MN 55391 <br /> IGoep a co�y for yoar reco�ds. <br /> YOU MUSI`OBTAIN ALL REQUIR�AUiHO�t1Z�4TION5 BII70RE BE�INNII�G yVORK. <br /> 1. ' L'e Name ,Fi�s1,M.I.) Pdo�e No. <br /> Addsrse �RFD,Box#.CitY.5tabo.ZiP) <br /> . .� <br /> 2. Location of�ro�oeed P�oJect(Aaach drawing w/din�cstio�bo sil¢): <br /> CQLTIV7X Q'PIt SEC'IxON(s) S�G'IZON(s) TOWNSHII'(s) RANc�(5) I.or,B1ocIS subdivision <br /> fi�s�w�+�p�'� <br /> p'RQIPCr ADDR88S• Jr'' C1TY: <br /> 3. LENGI'�i OF SHORfi AFFECTFD(m foec): VOLLTME 4F FQ.L OR FXCAVATION(Cub�c yffids): <br /> ARFA FILT.ED OR EXCAVA'TID�IS Acie.s,OR Squane l�eet, <br /> 4. 7YPE OF PIItNII'T BEING AP'PLIED INUR (Cboc.k alI thet applY): <br /> ❑STORMWA'lIIt MANAGII4�VT P'LAN ❑FLOODP'i.AIN ALTPRAIIQN ❑WE[7rA]W ALTIIZATION <br /> ❑�R�B OS"IiORM SEWIIt OUTFALLS C��N(DRfiDGING� <br /> aLl <br /> b�SANDSLANKEf ❑ICE RIDCaB RF1bIOVAL b,[]NAViCAZ70N <br /> c AII�IING WALL a❑BIOFNGIl�ER�1Q <br /> �RIDG�&C[T[.VERT CROSSINGS <br /> OTHL�R(DFSCRIB� 5:.�h�,.:�., l�e.� <br /> 4e. AP'PLICAN'1"s Rh�'RFS'II�TraTIVS:(lioensea eo�actoc,F�gineer,erc...) Incbade nume,ad�Osa 8c�nambe�: <br /> �� <br /> 5.PROJS�Ct'P[JRPOSS(qfiy ia thie projecu needed-avLat beae�its will it pmovide'!) <br /> ---� <br /> 6.ALTERNATIVFS(deacnbe any ml�er si�es or merhods dtat oouM be usCd to achieve tLe p�npose of yaur pooject wlule avaiding or <br /> minimizin,�w�t�lvvetlaod imp�cts. At�s�adctiaamal uh�ets,�needed <br /> �` <br /> 7,DATE,S: Pa+oposed ata�t of acdviry: 5�}. I S 03 Proposed compledoa: t��b. IS o4 <br /> wro�c an attached�awin <br /> 8. NAME�5,8�iA,pDRF.S.SES OF ADJOIrTIN(3 PRO�'ERTY OWrTIItS(Attach list if m�) <br /> 79/�{ <br /> 9. P'ER�DTS HAVB Bffi�I RBCB[V� (R)OR APPL�D g'OR(A)FROM:__„_.,,;pNR ARMY CORPS�ENGR <br /> OOUNIY_�CIT'Sl MlV I'OLI�JIION CONTROL AGII�TCY <br /> I Lueby norify the�cipierns of this form of tve p�oject.peroposad he�+e�n and requeRc I be advised of any pummb oc od�er d�s�inatiaas <br /> ca�oerrung ehis pcojec[��I musi obl�in.I undars�ud thaz p�oceeding wi�work befoQ+e aU toquucd�si�adons are oMained may be <br /> subject Stsbc local admmistradve,civil aud/ot ctiminat peualtic�. <br /> 9 s a <br /> s� rrraoo •xc o� nak <br /> D �G� II'�� <br /> D <br /> S�EP 1 9 2�03 <br />