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� <br /> � MINNEHAtiA CREEK WA7ERSHED DISTRICT FOR OFFICE USE ONLY <br /> ' ���� �9 14600 Minnetonka Boulevar� - . <br /> � �F� ermit Aaplication No. C/3 �/4 -� <br /> � - f�innetonlc�Al��E��4�e1&9�EEK te Received <br /> WATERSHED DISTRICT � <br /> '�—y�� ,� � �Ci • enda Date <br /> �9SHED��S�e APPLICATION FOR�PER��- �D9RM A <br /> �y i - �{72 Z <br /> SEE REVERSE SiDE FOR INS �� ���"��'''r''e' U d �'� r� 9 �2 " %7 Z G <br /> 1. OWNEA: 2 OWNER'S <br /> "�p(,� �j-�'���� REPRESENTATIVE: <br /> C ��«s,,�, � 2 �l � fl nI _ <br /> w,,,„,� � ,,�,°..� <br /> °%YYI i vt - Sl� �3�� <br /> a.+.aw�+ey �_ Wa) R�.�w�} Wa1 <br /> Owner's Signatu . • ❑P.E �R.LS. LA �OTHER <br /> 3. Project Location: �� a7 I i 7�3�f�-od� <br /> C �y��D Coun . 1 a Sec. " •� Sec. Townshi [ � Ran e�� <br /> 4. Proiect Address: -f'� • ' <br /> �. Permit Requested For. (Check all appropriate boxes) <br /> B. � Stormwater Management Plan C. ❑ Floodplain Alteration <br /> � Commerc'�al D. O Wetland Alteration <br /> ❑ Industrial E. � Dredging <br /> ❑ lnstitutional or Highway F. �S( Shoreline/Bank Improvement <br /> O Residential G. ❑ Stream/Bank Improvement <br /> NOTE: A licants La in Sandbiankets Must Use A lication For Permit - Form B <br /> 6. Describe ihe ProjecL <br /> �. �' L�N �nrb �'- 3' N-' - 5�-�ra2����E <br /> N �2�0 �'1� - I P- � <br /> � 'A1 1.J� �l ► I�� l,lC�lr?1 DI�S . <br /> (If this project requires municipal approvai or review, attach documer�tation of municipai review.) <br /> 7. Body of water, stream or wetland affected by runoff from this site: IUtJI�� <br /> Distance from project: <br /> 8. Schedule fo� construciion, implementation of temporary erosion control, substantiai completion and restoration: <br /> l,l.'POI�I i �'� �rL — ��r <br /> Please call (612) 939-8320 if assistance in compieting this form is required. In submitting this form, the applicant <br /> acknowledges all requirements for permit approval as determined by the published rules dated May, 1991. <br />