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JUN-04-2002 18�15 MINNEHAHA CREEK WATERSHED 6124710682 P.63/08 <br /> � oa- t N� . <br /> COMBINED�OYNT NO'�ICA'.�'ION FOYtM-WA1'�R RESOURCE App1,TCATION � <br /> Use this fvrm ta notify/apply to the Mvmehaha GYcek Watershed Disuict (MCWD),therr�ering���s,the <br /> 1)NR,and the Hennepia Conseavatian Diatrict of a proposed wa�sr/wetla�nd project o�work wluch may fall within.their <br /> jnrisdaitction.Theso ageoaios slrould�advise you of their jurisdickioa or permit rcquiremeats within 10 days.Fill rnrt this <br /> form compleb�ly aod mail a c°PY,with plan,maPs,ctc...ta the MCWD,C�ray Freshwater Center,Navan�,2500 <br /> Sl�adywood Road,Suite 37,Faccelsior, MN 55331, Ksep a copy for your recor�s,ypU MUST OBTAIlV ALL <br /> REQUIRF�D AiJTl�OKlZATION3 BSFOItE$EGIIVNING WORK <br /> 1. licaat's Name(I.at�PYrs�My) Pha�No. <br /> � . . .O .� / <br /> Addreas(Strect, � D Box#�Ciry,State� ' ) <br /> Z. Locadon ofPro�PmJect(Attech drawia�w/diroctic�s�u,sile): <br /> UNTY QTR SEC'IION(s) 3��(s) 1'0 '�s) RANCrE(s) Lot,Bloc�S�bdivieion <br /> PR��ADDRBSS: �J �.�D��� <br /> � a <br /> 3_ LENC�'!'H OF SHORE AFFECTLD(�f�eot): J VOI.UMB OF FJLL OR FXCAVATTON(C�bic yards): '' <br /> ARRA FII.LBD OR EXCAYATED IS: �►cros,OR Squ�e F�. � <br /> a. TY'p�OF P�RNIlT BEING APPLIED FOR (Chccic aU rhat apply); <br /> ❑STORMWATBR MANAGFII�NT P'LAN ❑FLOODPLAIN ALTERATiON ❑WE'i�A[.1�iA170N <br /> ���E IIV�ROVENffiVT �9TORM SEWBR DUTI'q.� EXCAVATION(DREDp1NG) <br /> e RAP � <br /> b ��� ���ID��V�- b. NAVI�GpTIpN <br /> c RL7I'AIl�TII�TG WALL BIOP.�TOII�ERII�TQ <br /> O'lI�R(DFsSCRIBB) OBRIDGB 8c CUC VERT(�tOSSII�TC�3 <br /> 4a. :AP]PY.ICAN7r•s RFPRlasnvrA�'tvE:(Licx�s�conaectc�,E_n�� ,eoo...) Taclade �t p�wne n„�ber <br /> ' • �DO 4/•d.R�E 5�.����.cs��.iD9•v,SS.�,3! <br /> 5. ROJP.C'I`P�7RP03,$(vyhy is tbis pzoj�t neoded- bcnef rs wi71 it ck?) • <br /> �EBu�s.D ��G/ST/N7s wq,�,�, _"�iPov�a��pS!ON Gp N T�P.6l. <br /> 6.ALTA1tNATNES(desc�be atry other sites or metbods that eoulc[bo�ed to achiev�tbt P�of Y'�P�'oJ�wbile avuiding a <br /> �xing waber/wctland iraipacts. Atluoh additional she�,if needsd, <br /> 7.nAZBs: Propesea soart of acrin►;ty:.5 ee,Iy A� eZ p���pic�on: �v.6L S/��— <br /> �i arock o�atrachod�a ' <br /> 8. NANffS&,AD C SES OF ADJOII�iING PRpPB OWNER4(Att�list ifmoce) <br /> � • S <br /> 9. PSI�MT19 I�AVE HEL�N RECElV6D (lt)OR APPL.�iD FOR(A)F1�QM.�ANR � ARMY CORPS O�BiVGR <br /> COUNN CIlY MN POLLUZTQN�N?ROL AGENCY <br /> I he�eby nod�Fy tl�c rEcipie�of tbie fo�n oFthe p�jeet�aposed haein and�quast I be advised of any permils�ott►er debermi�tia�s <br /> conee+7�ing this projcct t6az I must obtam.I unde�md d�ptoceeding with w�ic befo�e aR ra��ed au�s�c ob�od may be <br /> sub'ect to Pedecgl,Sfate�nd/or bcal administ�ve,civil�d/a crimioal panaldes. <br /> � . <br /> �� � . .� /'�— <br /> � <br /> , ,. �.. ..,,.�., <br /> . • • •�� Y • <br /> '� 1•�� <br /> ... t��� � � 2� ���`� <br /> . �.::=- . <br /> � .: <br /> • ' "aYi�:r <br /> �+.�l1��4 <br /> e <br />