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AUG-09-2004 16�09 P.02/04 <br /> . Permit # - <br /> SNORE�INE EROSION PROTECTIQN — FAST TRACK PERMIT <br /> MINNEHAHA CREEK WATERSHED pISTRICT(MCWD) <br /> GRAY FRESIiWATER CENTER <br /> 2500 SHADYWOOD ROAD Ph: 952-471�0590 <br /> EXCELSIOR; MN 55331 Fax: 952-471-0682 <br /> i,�'�� a,�r n e �s�ae ac�1�.�� h �r i�e � <br /> (Property Oumer) (3treet Address) <br /> �r4n0 ►"�N 5�39j � 9°�a-�-l��rauesta <br /> ` '---- — � — _ q pproval fo install�i ra <br /> ���Y) �State) (ZiP1 (Phone) p P <br /> shoreline erosion protedion on property described as �d �CNth Sh,o�'[. Q��`'�- <br /> ���p��j _ p �,.,t��et ad�s <br /> ,locatea in <br /> �r��'�'-` -��� e riprap installation <br /> (W'dhln tfie qry bounda�ies) (Cou�ty) (p�operty ID# (PtD# <br /> l� <br /> will consist of 1� along the shoreline of_.LYj�(�_�1���, r tG,Q, � <br /> ' (Linesl feet) ���� �Day _,._in fuil <br /> accotdance with the Minnehaha Cre�k Wate�shed District Shoreline Protection Guideline for <br /> riprap placement requi�ed for issuance of a Fast Tradc General Permit. I have coptra�ted with <br /> po�C, (.a�� ��✓b vha�,lt�ne, Ari v�, �P n'�' k�`� ��3g� <br /> pa�y) � ���83y3 <br /> (Name of Com (Street address) (G�y) ��p�� <br /> 9� � cPh�,o� <br /> (Bond Number) ' �tD pertarm the work who is familiar w�ith the technical <br /> requirements and has fuffilled the bonding'requirements of the waterehed district(see page <br /> two). I have read and understarxi the requirements of the MCWD rela'ting to Shoreline Erosion <br /> Protection. <br /> � cs►��n,re ,��y o�,�„a'�.,..—,� � ` �7 d� Q� . <br /> � (oate) `—'_ <br /> Subscribed and sworn before me on this^��day of�� � <br /> Q `_,20 O. <br /> Nota p,ub(ic - • ` <br /> ' , , 3WEP4YlA.lA�EPiNER <br /> NOTARV PUeuG�11M�ESOTA . <br /> ' ' • MY CONM186WN fe7�IRE$1-04,20?S <br /> Approved by: � <br /> . � <br /> Date <br /> � �isLibution: P <br /> _ ropsriY Owner _Condaclar _MunicipditY, _nNR _DlsUir,�Flle <br /> ' , Page 1 of 2 ' ' <br />