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RUG-13-2001 10�39 MINNEHAHR CREEK WATERSHED 6124710682 P.02iO3 <br /> -�. ��nTCD � w.J`�/tJ dS U � �1j1 . <br /> �601 13�21 MINNEHAHA CREEK WATERS ' 6 H�1710682 P.03i16 <br /> � AUG 0 81.�01 � C�� a� <br /> COMB�NEp J'pIN'T NOTIFICATYON FORM-`V T�;R RESOU <br /> . .� B�k'�AP,gLICATION ���i <br /> Use tfua fotm Eo notify/app(y to the Minnehaha Crc�k Watersheci Ditrttrict CWD their eA " e <br /> 1 tM ), B�n eri.ag cflnsultants, tL�e <br /> DNR,and the Hemuap�Consetyatian 17istrict of'a ptoposed watLd�uvotland pr�oject or work which may fell wlthin their <br /> jurisdic►ion_Those agencYes ahould edvfse you af thcir jurisdictio�or ptrmit raquirements within 10 days.Fi11 out this <br /> forai completely and mai�a copy,with plan,mapa,eta.,, Ia the MCWD�Gtay Freahwatcr Center,Ne,varre,2500 <br /> Shadywood Road,Suita 37,Excelsior, MN SS331. Keep a oopy far your records.YOU MUST OBTAIN ALL <br /> RLQUIRED AUTH�RIZATIONS BEFORE BBGTNIYING WORIG. <br /> � l. ApplicQnt's N (Last,Fi�t,M.I.) Phonc No_ <br /> J� � � � ySZ.-�f�� -�F3oo <br /> Addre,�,s(Srroee RFD Box#�C ity���)�L w . <br /> G1 r V'+ �:1 , I� `'1�1 N � .�� <br /> 2_ Loc.�Qon of propoeed projcct(Att�oh drawa►g w/dic+eerons to eite); <br /> COUNTY (�1R sECCION(R) s�CIION(s) TOWNBI�Y(x) RqN���a) Loe,Blocl�S1�.bdivieion <br /> PROJEC7 ADDRESS�2 �i , �, Q,, �Zy_ (,� <br /> 3. L�,NGT�OF SHORE.Ak��Ci'ED(in feetp a O VULUNffi OF FILL OR E.�CCA'VpTtON(G�bic yards): /3 L� <br /> AREA nILLGD OR EXCqVATED IS Acraa,OR Squatc F�ct. <br /> 4. 7'YP�OF PfiR1VIIT BEING APPLiFD FO� (Check el)thAt e�p1y); <br /> []51'oRMWAT�R M�iNAGEMENT PLAN L�FIAODPLA rN AL7'GRATlON ❑WET`LAN�D ALT�RAITON <br /> L�S�IUttEI.IN�;IMP1tOVIIr�NT • �SfORM SE'WL1i O�i7T�AT,�S ❑ EXGAVATION(DR�DGIlYG� <br /> a. RIPRAP ' a.❑Wrl.DtiI17B <br /> b. 3AND�I.,ANK�T []IC�RIDCE RBMO�►IlL 6L]NAVIGATION <br /> ° ��C'�'°'ZL c.0 BIo$NOtNTi�RiNG <br /> RIDC�&CUI.VB][tT CROSSaTI(i5 <br /> o�R(DESCRIB$) � ��"� � G+O�J aV <br /> 4a. e�ll'P�.ICANT'S R�PR�S�NTATiVE:(�,icensed Conttaeror�F�gin�cccr,eb�.,.) in�iudc nan�e,add�r.ss&phone numb�r, � <br /> � A'vll .S A(��1�Sl� <br /> S.PROJECT PURPOSE(why is thie pioj oct nccded-what bcuafrls will it pavvide?� <br /> �J fi�.1 VWwF C,���rST, <br /> 6.�;LTk'1tNAT1'vES(deScribe any other sites�methvdg thst coutd be used ro achieve cAe purpoec of your pmjcct wi�ile avoidiag or <br /> mitumizmg wat�er/wetland impacts. At�eh�dt�itiow�l shxts,if n�cdul. � <br /> 7.DAT�B; Pcuposed 6cRr�of Haciviry: �]V 1.� O � Pnaposed yonapivtion; �� O Z <br /> (Tdrni aa wm letod Wrnic on alffic6ed�awin <br /> 9, NA�S&ADDit�SSES OF JCD70INING PROPERTY OW1�R5(Aa$ch liet if moca) <br /> 9. �ERMl"rS HAVT 8� N l�k�C$NHD (R)OR APPLIDll FaR(A)FR014L�pNR ARMY CORPS OF EI�iGR <br /> COUNTY�CTIY M1y p011,U'110N CONTROL AGLNC'Y <br /> cby n ' y the t�eiplen�ot d�i of the projcct proposcd hcccin end nqucst�I bc eJvld�d of any.po�mity ar othcr dctcrrt�ina�ons <br /> oneen�o�g d� Deoject t I mus in I uncleascead that ptnc�eding wlth work beforc alf�quired wrchori�,ations ar�abceincd may be <br /> ede al,8tate d/or adminisccavve,eivil and/or oriminal benalties. 1 a <br /> 0 <br /> c�soti Pro osin 'cct ar t Da�e <br /> \ � _... <br /> r <br /> ; . <br /> . � . <br />