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� a ��tl'��: .c �� o � .�� _ . JHN �� EJ17 � 'WATER RESOURCE PERMIT �.'rrrn►r v�nnu vae this�rm to notityJapply to t�Ca Minnehaha Cregk Watershed D1strlct(MC ay fell witliln their jarisdicdcx�.Fill out this fOrtp completely and suhmit with your sita plan,maps,etc.to t�MCWD at: 15320 Minnetonka Blvd.Minnetonka,MN 55345. Keep a copy fifi�rr your reoorda YOU MUST OBTAIN ALL RE UIRED AUTHORIZATIflNS BEFORE BEGIlVNINC}WORK. 1.Namc of each praperty own�: Shields,Mtke and Meliasa Mailing Addrass: 800 Lanewood Ln C�ty; Piymouth State: MN Zip: 55447 Emafi Addres�• Phone: F�• 2.Praporty Uwner Repreaentative Infocmation(not required)(lic�nsed Qontractox,architect,eagineer,etc...) Business Name: �K Buildera, Inc. Representative Name: ��'Y or Grag Kuperue Business Address: �2125th Ave Clty; Milaca $�• MN Zip; 56353 � Emait Address: Idkbuilders�gmail.com,gregQldkhomes.c phone• 61�859086,7832449001 g�; 3.Projcct Address: �9 Minneeonka Highland Rd City: Orono � State: Mw �;p; 55356 Qtr Soction(s}: Section(s): � Township(s): Rengo(s): Lot: 3 Block: 2 Subdi�riaion: Minnetonka Highland EstaEes pip� 0611723440007 ; 4.Size of project parcel(squaro f�t or scres):42,OBs SF � Area of di�sturbancs(squara fee�t): Volume of axcavation/fill(cubic yar�cls): ' Area of oxisting impervious aurface• 9,18b Area of proposed imparviousi stuface: 8,773 ; 1.angth of shoreline affected(�Geet): . Waberbody(�t bay if appliQablo): �� S.Type of pa�mit being applied for(Check all tfiat apply): m EROSION CONTROL ❑ WATERHODY CROS3INCi5/STRUCTURES � ❑ FLOODPLAIN ALTERATION ❑ STORMWATER MANA(iEMENT ❑ WBTLAND PROTECTION ❑ APPR�PRIATION3 � ❑ DREUQINC� ❑ ILLICiT DISCHARGE ❑ 3I�IORELINE/STRBAN�ANK STAHII.,IZATION � 6.Projoct purpose(Check all that aPP�3')� � G� SINdLB FAMILY HOME � MULTI FAMII.Y RESIDBNTIAI,(�rtnaents) �_ C1 ROAD CON3TRUCTION ❑ COMMERCIAL or INSTITUT.[ONAL Q UTILITIBS ❑ SUBDIYISIONS(ina[udo m�mber of lots) ❑ DREDC�ING ❑ LANDSCAPINC�(pools,berma,�tc.) ' C3 SHORELINE/STREANIDANK 3TASIY.IZATION ❑ 4THER(DFSCRIB�: '7.NPDE3/SDS Ceneral Stormw�er Fermit Number(if applieable): 8.Wa�srbody recoiving ntaoff from aite:Lake Minn�tonka 9.Projoct Tiutelina: Start Date: March 2017 Completion Dat�•A st 20t7 Permits 12av�bean applIed far:City d County C�MN Pollution Couirol A�ency �DNR �COE 1� Permits have t�received: City^�Cownty—�MN Pollutlon Control Agency�DNR'�COE—� By signing below,I hereby request a perniit to a�rthoriLa the activities d�.aaribed herein.I certify that I am familiar wi�MCWD Ral�end that dta proposed aet[vity will be oonducted in aompliance with these Ruioa.I am familiar with tho infonnation containecl in thia appltcation and,to the bast of my�owledge and bebtef,all intbrmaHon i�tnu�complete and acctq�ate. I unde�stand thai pt+nceeding with work befnre atl reqoirod attd�orizations aro obtaiitted may be subject to fiedaral,si�ete and/or loce] administrativa,civil and/or criminal p�taltiea. t ��—Z-- _ � ��-�� a��i7 Signahu+e of Badi Pnnpedy Ownar ' Date ;;,_:;�� .��1:`1;i1 i:. �'i�i?< � £:�i i ' t � � a s: �