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HomeMy WebLinkAbout1994 - MCWD app for permit to replace lost soil �Nc r,A c MINNEHAHA CREEK WA"�ERSHED DISTRICT FOR OFFICE USE ONLY �� 9f� 14600 Minnetonka Bo MI CREEK kirAG � Minnetonka, MN {g§iisHED DISTRICT Permit Application No. 9L/ - / Date Received Notice Sent " '~ JUL 0 5 1994 Agenda Date 9 • SHED D\C. APPLICATION FOR PERM or D SEE REVERSE SIDE FOR INSTRUCTIONS 1. OWNER: p 2. OWNER'S 5tzOhet1/4) 11•;" "4- REPRESENTATIVE: ('o-t16z )-.a-r.S.Sc2.;µ `' -,� (Print orType) —�CS1 . "Ci L34,41r � . o .�-. S331 3 i S 3 rw:.,.t \-...4.\-...4.,,,,_ '�+. o LA^^di iJ (Addsss) (City] (Address) (City) if7 / - x-7"73 -2.1-72_ - 4( (C4 SS3C,`/ (ieknone) _ RIP) ;._.„..4.1 (Telephone) (Zip) til- Owner's Signature: J.-6,/ (, A ' � 0 P.E. O R.L.S. 0 LA 0 OTHER 3. Project Location: P, D 'i_t_ Z i - O 1 - 7--3 — 000 3 City 0.h.):3-n-.0 County 1/4 Sec. Sec. Township Rance 4. Project Address: . 5. Permit•Requested For: (Check all appropriate boxes) B. ❑ Stormwater Management Plan C. Cr Floodplain Assn ao, . R ,u.?... ❑ Commercial D. 0 Wetland Alteration O Industrial E. 0 Dredging O Institutiona' or Highway F. Shoreline/Bank '. -•Drovement Residential G. 0 Stream/Lake Crossings NOTE: Applicants Laving Sandblankets Must Use Application For Permit - Form B 6. Describe the Project: 1l o. _g_ curs L r O - `.U�c J\s,S ot .9_0 .,-1- I 3 0 t.Q --\-ec 1 w„)-0\ V-J\a..4-s 6 6-4?..-\\.1/4.."1/4.b.6-4?..-\\.1/4.."1/4.b. n 1 f$ Adt (If this project requires municipal approval or review, attach documentation of municipal review.) 7. Body of water, stream or wetland affected by runoff from this site: 1.c�‘<-4_ YYl4-100. :. SL.b\a.L Distance from project: 8. Schedule for construction, implementation of temporary erosion control, substantial completion and restoration: Please call (612) 939-8320 if assistance in completing this form is required. 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