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HomeMy WebLinkAboutwater resource application _TI IL ='=�-1'�'�;-� i�:�=t= f�lIhlhlEHHHH i=FEEI: I,:li--�TEF"-�HEL:� r,1�4�1�-�r=��' F'.�-��' '�-��' -/ o �/J % �pMBIlYEp ,TQ]N'T' NQ'TIF'�CATION FOR.1V�- VVAT`�R RES4URCE A�PLICATX�N �P� � Use ihis �arm ta notifyla�ply�fi1►e Ivf anehaha_��re.�k�UVatershed Uistrict (MCWI]),their engineering consultattts, Lhe rjN� and the F-ICttnepin Conservation T]is[riCt of a pmposed water/weiland project or wor�c which may fatl u�ithin thelr j�risdiction:`.-"fliese agcn�cies`shouid advise'you��f tlieir jurisdiction Qr pemtit neyuiremenis wichin•�14 days::�Fill out this foz�i i:oriipietely�iriai[ a�capY,`witb`plan;��►i�ps;=etc::. the'MCWD,Gtay Freskiw�r Center;Navarre,2500 Shady�vood Road, Suite 37, Excelsior, M�*1 55331. Keep a copy for your r�cords. YOU MUST(3B�'AIN AI:�..REQ[J�tE1� AUTHO1�iZA.'Tf ONS BEFQR�SEGINNINCr WORK _____ _. _� {,;: ,r c.,. .;��.r.. .. . - . . . . . - 1 r . , . -. . . 1. Applic�nt's Name(Last,First,M.I.} - Phone No_ `}�s��,:�''�i�r' ���:},', � �,�'��''�,�'n'BPv ': _. � �� �e-t�iJ�4 9,� :7� Address (S�eet,RN�?:;�o,x#,Gity; Stat.'��A�r:=4 �:i�r4'��° �: s :� , ,: :- a5 00 �fi� w� �Ad� ,��� ��.� M�..,.' ss�.� 2_ Lacsrion of pr�oposed p%�ect(Attach drawing wldirccuous ta site): . _ �._... . COUI�ETY ''" � •�Q'�'R SECT14N(s) SEC'�'ION(s) ��''I'OWNSHIP(s) RANG�(s) Lo� $lock, Stibcl�vis�on ��r,,��<N �a 1�`� �.3 � PROI��"I'A�DRESS:i�. �:. . ��: .. ;�;i�. , , ..� , , _ . , . .. 3. �..ENGT�I OF SHO1�E AFFECTED(ir►�eet)'-"',@ VOLUME OF�[LL 0R EXCAVATIDN(G11bic yards): AREA FILL�D OR LXCAVA�.1�1S Q Acres,O� � Square�'eeL -�.:���ia,, j:. �:A�-: . .�- ' . , .��ii[�i; _.'7 , _.._. . ��I:� . .,,. '��-.-�� �rT7��. �... . . . ' , . - - . � 4. 'I"YPE O��ERMIT BEING A.PI'LIED�OR:'�`(Check all that apply): ,- �' '�'' - � _ - _ r ��:: �,- . _ , . c:, -. _ ry-. . _ ❑ STORMWATER MANAGEIvi�NT 1�LAN ❑F1�QODPLAIN ALT�TtATION 0 VYET�.AND AI-TERATION [�SHOR.ELINE IMPROVEMEN"C. [�STORM S�'��ER OUT'FAI.LS � �XCAVATIdN (D�DGINGI a.[jItIPRAP- , ,; - a.Q �VIT.I7LIFE b. SAND�LAN�T :QIC��tIDGE REMOVAL b.0 NA�'IGATION Q c: BIOENGT2�rEERTNG c.[�RE'I'P.lNING�VALL � n C]BRIDGE& CULVERT CROSSINGS O'I'HER (DESCRIBE) t�� S u►� ca4 i vvr lat�.l2i'v 14t2..�!'.� 4a. APPUTCANT'S REPRESENTATTVE' (Licensed Contractor,Engineer, ctc...) I�iciude n�eteT�pl�����er �V'f v�W cQT�e2 ���.1,-t�l�"��ic'l� �i�k F- 5, �RU�CT PURPOSE (wh_y is tlus project ner�led-what benefits will it pfoti1de?) �/�m LJr �� /�!v�I?7 �L����� �� /"`•4�-l�l-t�' �- �-�s , 6_ Ai,TERNATIUES (describe any other sites or methods that couId 6e�sed to 3Chieve tlie p�u�4se� yrour pr�ject u r������� or mir�imizing water/wetland impaets. Attach additior�al sheets, if needed. /t/C �E 7 DATFS Pr�posed st�rt of activfty� Proposed complction (Idcntif�;� any completed work on attachcd dr,�wulg) S NAMES& ADDRES�EII?/QF AD101N7NG ROPERTY OWNERS(Attach list ix mor�) �`- �_`Su�t.tU.+ ,vr � fU.4va��°�,�,��/ � ' s�c�ta�.T /�u�J 1�s1�77 o�tJ 9. PERIv1ITS HAVz BEEN R�CEIVED (R)OR APPI..TEB FpR(A)FR�M: DNR .�EtIvFY COR�'S OF �rJc1�. CQU]��TY CITY MN POLLUTTON CQNTROL AGENCY I hereb�� notify the recipicnts af tius fortn of the project proposed herein:�id request I be advised of any permi�s or other detepfiuna'u I_ _ ' g this proje�t th�t I must obtain. I tutderstand that procecding«�it�t�vorlc before ail re�uircd 2uttlorizati� are,'obXi � �i�y su .�ect to Pederal, Statc 2nd/or lacal administra[ive, civil andlor 'minat penalties_ '� 7 �9 9� 5i turc ot e 5 n . oi�osing Project or Agent Dat _ TOTHL F'.�_��,