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FEB-11-2003 11�35 MINNEHAHA CREEK WATERSHED 6124710682 P.63/03
<br /> J1ilrL171aturAl.� t i.au�u i w �rn..L vv vs..... .�.�.........�� •. .•_._._
<br /> MIrf�JEHA�IA, CREEK WATERSI-�D DISTRICT
<br /> -�: v — Obo
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<br /> j, F Y w+n �YV�i� _—residing at 5Dr1 �.�rK �.ou� , �oY�Q�I�I N 5�3�570 � --
<br /> prnpe�ty O!�vn,er Add:+ess C'ty,Statc'TaQ� .
<br /> r2 5� 5�0. ���.IrW�(JI 1� ' , Or PID# .
<br /> . Phonc County TownsydQ,secrion,itsi� tfi�n P�vpz�h'.�x sta t�
<br /> own and occupy the abave sin,�le family residence'and wish to i�.stall�a sandblankct on ' � , ' '
<br /> . , , . .. . . ,
<br /> M��rw��e�anl�ca., Nov�,_�vr►^ � . . . . �
<br /> Lnkc Bt Bay . : (
<br /> �nr�e.-� I-+� at 3�aa Mtadav�;� � � � � � � �
<br /> ' '�, I have contracted with , ' � '
<br /> � sddicss �.
<br /> �XC�C�IS►(3V'� 1���) �331 � , ��./U'ly-7�13� ;.to install clean sand from�tkc followin�, sou ::>: . .
<br /> �ty,state,ztp , p� ' . �. ' , a
<br /> '�NrYI (�lUl-f�_I-Q,1r ' �3 I 'Pc�X K fl�/� �(�.X�'1IDItirOf � NIN_, °15?-� �1�7-2`7�-U,or: .
<br /> — ��� . ..a� : phonc ,
<br /> ❑ I will insta.11 the sandblankel�mys�l�from the following�aurce. _ � �� , �� : ,
<br /> • . . supPi�'T • .
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<br /> _ ' ' •� .' , .
<br /> • acldrtss .'' phona ' ' • ' ' . ' . . .' .
<br /> If thi.s pxoject requir�s municipal approval or review,plcase�attach documentatiori�of th�.riiunicipal approval
<br /> Y
<br /> wiEh this application. My shoreline is ��� fee��and the dim.ensions of the prc��i;d;�s�3ndblan�et are:
<br /> � . .. . ... :..
<br /> .•.:r �.:
<br /> �j'p� ���h� Y /_D (���f�) X G (pepth). Sandbl.ar►kc:t dimensions•�cannot�exceed a
<br /> length of 50' (or 5096 of shoreline),a width of I O'and a depth of 6". � � �
<br /> I understand that if this application is nat completely filled out, or if I fail to�submii the requ' d exhibits,.
<br /> the application is incomplete and will be returned Jt will not be reviEwed.by MCWD staff unt completC.
<br /> Sy signir�g this applieation, I agree and und�rstand that th� I7is�trict may enter the px�operty at easonable
<br /> hours to conduct �t insp�otion to determine whcther the t�rms af the permit are being met I fur�her
<br /> understa.nd�that if I violate the terms and conditions of a permit that is issued bAsed upon this application,
<br /> the District shall eonduct a field inspeetion of tlie project per MCWD Ru1e J, provided'with this applieation.
<br /> I understand thc District will charge fees to cover the actual cos�ts of field inspecfiox�s, includit�g i�vestti,gatior.
<br /> of the area affeeted by the w�ork,analysis of the work, including the sex�vic:cs of legal courisel and englneers,
<br /> and any subsequent monitorin,g of thc work The District's actuai costs are dcemed to begin accruing when
<br /> tkte ' ' su�s tice of the v�ol.a#ion to the permittee_ I have read and understand the MCWD Teehnical
<br /> C,ui anlrets. �
<br /> ��� �C�3
<br /> Sxgnature of property owner Date
<br /> Subscx�ibed and sworn to before mc this �� day vf �� � �v3
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<br /> ��7 SNERYL A.LATTERNER
<br /> a , NOTARY PUBUC�MINI�SQTA
<br /> MY COMMIS$�qV E�{PIRE3131•2p05
<br /> 'otary Pu ic ■ .
<br /> ����-� � � �_�.��.�.—
<br /> Approved and A�cepled by Q�p0� Date
<br /> ��er,District T�chniciiut � ,��� 1 ��ai-n�:as
<br /> �w �Bd�.t ��C�1V�
<br /> TI"IT/�I 1'Y I'9�!
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