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��t/� � �--C.� . D � U� � � � � Print Form. �� SEP 0 2 2010 � , Permit# - �6 Sandblanket Permit and Sand Source Exhibit Form FAST TRACK PERMIT MINNEHAHA CREEK WATERSHED DISTRICT (MCWD) 18202 MINNETONKA BLVD. Ph: 952-471-0590 DEEPHAVEN, MN 55391 �ax: J52-471-0682 - � Ryan Alness reside at 1169 North Arm Drive Orono (Property Owner) (Address) (City) , MN 55364 , �952�452-0699 request approval to install a sandblanket on property described (State,Zip) (Pho�e) as 1169 North Arm Drive , located in Orono Hennepin (Streetaddress) (Within the City boundaries) (County) 07-117-23-14-0027 on Lake Minnetonka _ Forest Lake (Property ID#[PID#]) (Lake) (Bay) �I have contracted with Better Yards and Gardens 9840 Hwy 1 D NW (Name of Company) (Street address) Elk River, MN 55330 , �763 �421-5439 to install clean sand from the (City,State,Zip) (Phone) follow�ng source Barton Sand and Gravel 11711 221stAve NW Elk River, MN 55330 (Supplier) (Address) (City,Zip) �763 3425-8663 (Phone) � I will install the sandblanket from the following source , (Supplier) , l � (Address) (City,State,Zip) (Phone) My shoreline is 50 feet and the dimensions of the proposed sandblanket are: 20 feet X (Length} 6 inches X 10 feet , Sandblanket dimensions cannot exceed a length of 50' (or 50% Of shoreline), (Depth) (Width) a width of 10' and a depth of 6". If this project requires municipal approval or review, please attach documentation of the municipal approval with this application. I understand that if this application is not completely filled out, or if I fail to submit the required exhibits, the application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. By signing this application, I agree and understand that the District may enter the property at reasonable hours to conduct an inspection to determine whether the terms of the permit are being met. I further understand that if I violate the terms and conditions of the permit that is issued based upon this application, the District shail conduct a field inspection of the project per MCWD Rule J, provided with this application. I understand the District will charge fees to cover the actual costs of field inspections, including investigation of the area affected by the work, analysis of the work, including the services of legal counsel and engineers, and any subsequent monitoring of the work. The District's actual costs are deemed to begin accruing when the District issues notice of the violation to permittee. I have read and understand he MCWD Technical Guidelines for sand I nkets. � 1 �_,._� %�. (Signature of Pr e Owner) D ej Subscribed and sworn to before me on this day of , 20 ; , i I Notary Public ' Approved by: Date I� ; ;