Laserfiche WebLink
��� <br /> Permit# I Q _ . AY 2 0 2010 <br /> Sandblanket Permit and Sand 3ource Exhibit Form <br /> FAST TRACK PERMIT <br /> MtNNEHAHA CREEK WATERSHEO DtSTRICT(MCWD) <br /> 16202 MINNETONKA BLVD. Ph: 952-4i1-OS90 <br /> DEEPHAVEN, MN 65391 Fax: 962-471-0682 <br /> I, S,m Q�kec��n resideatl�9�-t C��.11 �-� ��"�4'tG-RcR �_ " +'M �i�� <br /> (Property Ovmer) 6{,L (Addrass) (City) <br /> �N �S��I�t , (g�__�o� �G(,S request approval to install a sandblanket on property described <br /> (Stete,ZtP) (Phone} � <br /> as_. ► 3'S1 f�m�,�. Q,.�, �� , located in_ C3�r,� , <br /> (Street edtlress) (VWlhln the City bounderfes) (Counry) <br /> �7-1 tr� ��►�1 aoSl on �'Y� �k,� , ��� i.�Lkti . '� <br /> (Property ID�k[PIDAj) (Lake) (Bay) i <br /> I have contracted witfCONCEP'i'i.p+NDs�'�N'� ' <br /> 315 , �� ) (Streetaddceas) II <br /> ����,�'� � tc ir�staii clean sand frorn the i <br /> (City,State,2ip) (Phone) <br /> following source 'f�1,..�2.� ��.�, , L��,��� <br /> (Supplie� (Address) (C�tY.2iP) <br /> �-���/ 4�8—+-I l�`.� <br /> (Phone} ; <br /> I II insxaN�the sandblanket from the followiflg�source____ ,�-- � <br /> � ' ! .. <br /> t r' , :.�-'' '�1 .�=''`(s��ue�> <br /> ,' � �`-",. � <br /> �A��� " (Cfty,5tate,21p) � (Phone) <br /> My shoreline is�_feet and the dimensicns of the proposed sandblanket are: :��1 � X <br /> + (Length) <br /> � X t o . Sandbianket dimensions cannot exceed a iength of 50'(or 50%of shoreline), <br /> e�� �0 t�df�i1"' <br /> a width of 10' and a depth of 6". If this project requires municipai approval or review, please attach <br /> documentation of the municipal approval with this application. <br /> I understand that if this application is not completely filled out, or if t fail to submit the required exhibits, the <br /> application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. 8y <br /> signing this application, � agree and understand that the District may enter the property at reasonable hours � <br /> to conduct an inspection to determine whether the terms of the permit are being met. I further understand that <br /> if I violate the terms and conditions of the permit that is issued based upon this application, the District shall <br /> conduct a fleld Inspection of the project per MCWD Rule J, provided with this application. I understand the I <br /> District v�ili charge fees ta cover the actual costs of field inspections, including investigation of the area I, <br /> affected by wo ; a�alysis of the work, including the services of legal counsel and engineers, and any I <br /> subsequ t ' ring of�he work. The ' ' t's actual costs a�e deemed to begin accruing when the District � <br /> issu ti��o the viola'ron to pennitt e. I h ve read and understand the WD T chnical Guidelines for <br /> sa dblan ts �— <br /> _ -- - �s l 1 a ; <br /> ..~(Signeture ProPertY��) ( ete) I <br /> kt� ' d�and sworn to fore me on this t"t��` da of , 2p I� , ! <br /> � �;; JAMES HAROLD SMITN <br /> � ��' '� Notary Publtc � <br /> Notary Public �° Minnesota <br /> � .� My Comm.Explres <br /> `��"`� J�n 31 2015 i <br /> Approved by: Date 5 � l�' li <br /> I <br /> i <br /> � <br /> � <br /> � <br /> i <br /> � <br />