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s� Received � <br /> LAKE SHORELINE STABIL14VION _ <br /> PERMIT APPLICATION F <br /> MINNEHAHA CREEK WATERSHED DISTRICT (MCWD) <br /> 15320 MINNETONKA BLVD. Ph: 952471-0590 <br /> MINNETONKA, MN 55345 Fax: 952-471-0682 <br /> 1. Property owner information: <br /> $� � <br /> Name of each property owner: ��t1� `'' Nu� &!)I A� � <br /> Mailing Address:76,C) -Toak 11, _rx A. City: C&Ad Le�t-& State: My Zip: <br /> Email Address: G� r f�! �� � t (—L Phone: <br /> 2. Contracting company information: <br /> `C U!k%A,�g `alk <br /> Business Name: !Representative Name: <br /> Business Address: C.061,6State:N_ti_Zip:S 357 <br /> Email Address: p )YL Phone: <br /> Ongoing performance bond with MCWD: ❑Yes ❑No Bond Number. <br /> 3. Project Details: <br /> Project address: Gb I o��a t� City: L LAUe Statey <br /> Al -Zip: S3 <br /> County: Pii��1(J 1 n Property ID number(PID):_ <br /> Type of Project: ❑Vegetative restoration ❑ Bioengineering XRiprap ❑Retaining wall <br /> In-kind replacement: XYes ❑No Erosion intensity score(if not in-kind replacement): <br /> Located on lake: �CkV Length of shoreline affected: JC�o (lineal feet) <br /> Describe any existing structure along shoreline: <br /> Access to project site by: Vice ❑ Barge ❑Upland corridor <br /> Financial assurance bond acquired: XYes ❑No (If not an ongoing performance bond please fill out next page) <br /> By signing below, 1 hereby request a permit to authorize the activities described herein. I certify that I am familiar with MCWD Rules and that <br /> the proposed activity will be conducted in compliance with these Rules. I am familiar with the information contained in the application and,to <br /> the best of my knowledge and belief,all information is true,complete and accurate. 1 understand that proceeding with work before all required <br /> authorization are obtained may be subject to federal,state and/or local administrative,civil and/or criminal penalties. <br /> Z— I <br /> Signature f pr perty owner or contracting representative Date <br /> Page 1 of 2 <br />