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JUN-06-2003 15�29 MINNEHAHA CREEK WATERSHED 6124719682 P.03iO3
<br /> Permit #�i►e'' .C�, 3 -- Z .31 .
<br /> SHORELINE EROSION PROTECTION-FAST TRACI�C��P�El�1�llfiF; �:��. . .
<br /> � MINNEHAHA CREEK WATERSHED DISTRIGT �
<br /> , Gf�A`r' t=RESHWAT.ER CENTER � � , . . � ��.Ph: � 471=059n . .
<br /> �, 2500 SHADYWOOD�ROOD � � � , � FAX:471-0682,
<br /> � � EXCELSIOR, MN 55331 � . . . . �
<br /> . . . . :.,.
<br /> . I, ��1e5 ���%1-` reside�at �U .Sh� ,, � � ,
<br /> � (Property Owner.) , . � (Street•Address) : . � �� �.,..
<br /> (���o n o , VV��t .,SS39'( � �,`��'1�-�"I I.��S.�� requ�est.a.p{�royal�to.t� � � .:
<br /> (CiIY) (State) (Zip)� ' (Phone) ' •� ��..'+
<br /> " , , � , • .
<br /> . riprap shorefine erosion protection on property described as a�!fpb������ad�l w��-,,Jocated;i� �
<br /> . ' � '� �-�(s'tr�eeta'd'dress)�; ;;.,. " .�„`'�•�. . : '
<br /> D�a�r►o , ��n . „t�= 1 i�� �Z3 31 ao:s2:.:�:Th�e r�p:ca���irt�ta��atior��.: � �.
<br /> (Within the City boundaries) (County) � (PIQ#) � •� . � � � ' � ' . ' ' • 4
<br /> . ,
<br /> � wi(I consist of Z�o afong the shoreline of VV�;,,�n,�i�r,�,`�,� . � ,, Cr � �,�� �; :�in.full �
<br /> � � �lineal feet) (Lake) � � , �(Bay� ' '� � .'
<br /> � accordance with the Minnehaha Creek Watershec� District S�horeli�e„Pro�ection�:�td��ine:�far .: ��
<br /> riprap p(acement required for issuance of a Fast Track General:�P�.� r��it�_�i�havie"�contr��cfied wi�h � �
<br /> _ ,../ . ,..,,. ' . .
<br /> . . . l�oc,� � �� Lr�c. , 3�qo M�ac�.�u� [:� �ce[�,� , a�2/����83+�� �
<br /> (Name of Company) (Address) (Phone) '
<br /> . 3q88'�+°� , to perform the work who is familiar with the technical requirements
<br /> (6ond Number) •
<br /> and has ful#illed the bonding requirements of the watershed district (see reverse). f have read
<br /> and understand the requirements of the MCWD relating to Shoreline Ervsion Protection.
<br /> . .5 /�1103
<br /> ignat re of Property Owner) (Date)
<br /> Subscribed an om to before me on this ��r c� day of m� , 2003
<br /> . 6NlP1YI.A.LATTLRNER
<br /> � ' Mr�I O�i�►��
<br /> Notary Pub M .
<br /> Approved By: � s Date: ������_
<br /> Dis�ribucion: _ ropaty Owner _Contractor _Municipa�ry _D R _Di �� � � �t� � ';�;
<br /> , j
<br /> !j?.
<br /> � . ,''i
<br /> r •�
<br /> J�I� � 2 ����;,, ��
<br /> TOTAL P.03
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