HomeMy WebLinkAboutMCWD permits FEB-20-2009 15�16 P.02i02
Permit # (.:�.�- d 3�
Sandbfanket Permjt and Sand Source Exhibit Form �
FAST TRACK.PERMIT
MINNEHAHA CREEK WATERSH�D DISTRICT (MCWD) � �
18202 MINNETONKA BLVI?. Ph: 952-471-059C1
DEEPHAVEN, MN 55391 F�x: 952-471-0682
, I � ,�� ) a � � ' � � � ; __.��rar� o
I, 1!�1 f I l 1 YI!\ reside at
(Property Owner) (Address (C��Y)
'��? h , (_) � request approval to install a sandblanket on property described
(State.Zlp) (Phane) • ,
as , located in � ,
(Strcet address) (wlthln Ihe Ch,y boundarie9) (Caunty)
��3�-�� "�A�I��
���-ll�- ,� o .s' on � , / add�es5
(Property ID It�PID#]) (Lake) (Bay) �b
❑I have contracted with se ��r ��_�� N'� , _r� �l� �)G-J 1 e�� ��Ew'-��f
�Name of Compsny) (SUeel addr es)
�f Q y� �� v, s 5'�y�� , ('j¢�)�7f1�/S yC� __to install clean sand from the
(Clty State.Zip) (Pho�e) ,
following source S h a l�o n c � �r�u� ( - � - - � �'
(S pplier) - (Address) (G�Y��P)
� � � �� � � �
(Phone) ��7 ��
-►r
❑ I will install the sandblanket from the following source �.�� Ra�( � d ,
(Supplier)
-� . � �� , .� y S s�7 , c�) yo.3 - y 9� 6
(Address) ' (cily,Sla e.7Jp) lPhone)
My shoreline is IS'U feet and the dlmensions of the proposed sandblanket a�e_ �� X
� (Length)
,�^X�. Sandblanket dimenslons cannot exceed a length of 50' (or 50°�of shoreline),
(Deptl�) (Wldth)
a width of 10' and a •depth of 6". If this project requires municipal approval or review, please attach
documentation of the municipal approval with this application.
! understand that if this application is not completely filled out, or if I f�il to submit the required exhibits, the
appllcation is incomplete and will be returned_ lt will not be reviewed by MCWD staff until complete. 6y
signing this application, I ag�ee and.understand that,the District may enter the property at reasonable hours
t�conduct an fnspection to determine whether the terms of the permit a�e being met. I fu�ther understand that
if I violate the terms and conditions of the permit that is issued based upon this application, the District shall
conduct a field inspection.nf the project per MCWD Rule J, provided with this application. I understand the
Distr(ct will charge fees to cove.r tho actual costs of field inspections, including investigation of tha a�ea
affected by the work, analysis of the work, including the servlces of legal counsel and engineers, and any
subsequent monitoring of the work: The Distrlct's actual costs are deemed to begin accruing when the District
issues notice of the violation to permittse. I have read and understanc� the MCWD Technical Guidelines for
,. S bla�s , � � �� r � !/�� � �
� �� �C���
(Signature of Property Owner) � �� (Date)
Subscribed and sworn to beforr�me on this � � day of � 2�
� � o � C� � � d �
Notary Public � �EQ 2 � ?QQ9
Appraved by: � -� �� � ��`.'_. Date �� � � 1
TnTcai P c��
MAY-09-2005 10�52 P.02i02
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A�NN�T-�4HA CREEIC WA'�'ERSHETJ AISTRICT
---------�. pewKcr�a_1
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�� esiding a��� V � ���
Pro�erty Ow�eer �n.�.t Ciry,s�a�e,%i�� �—
� S , �3�1l�-23�2 • d0� ar PtD# 23 /17-�3-3a-(��
Plione Gounly Townslup�$r,tlicR�Rtnge (�m ro «
p In-•Y lAX atntc:meqt7
owx attd occ�zpy the above single fi�mi�ly residence and v,►ish to install a sandblankcF o►�
� h.KA 6(�/_�,Q,�.
l�kc&Bwy .
� I k�avc contracl�Cd with�i.���? I`fd c��g/p�,•� �.f 40 (,Ei�Ce��'Yer,f'
�/ �'I/ � � coqtreetqr ���/�'� aJd,rs5
��'�=uy fv��� �. �"y� '9y3� to instalf elean sand f��arn t��c following soura
elfy,sldte,2ip �hDne
...�m�1Jd��� I a�k/4d�enU�� N��du� Ml��5�9�2 y�7-Z
�PD�cc addrC55 � �flibilc �� �CI':
L._I d will install the sar.dbl�,tticet myse[f f�rn the fotlowitl�suurcc_
u��,r'�r
�,.A�7CSs 1 „ __ ..
phone
(F lhis �roJ�.l rcqui:�es muniaipal approval ar vi�w,plcase artar.h doeurr�erlrakiotl of tke �n�ni�ipal appro�
wi t�7 this x�pplicatian. My Shoreline is�,,,__� Ecet a�id Ff�e�jmensiviis o(the proposed sat�d�la�,ket a�•��
` � (I.ertgth; r. /U� (Width) x�,_ (penlh), Sandblailkc:t dimcnsionc cani�o� ex�e�d a
lcr�th of 3G' tmr go96 af shot�cline),s width oC 1 a'aud a dcptk oF b°,
1 undcrsttind tkt�i if thi.s app�ira[ion is not counpletc,ty F"�ct( oul, ur i! ? fail t� submit the -equired exhibi
�he application is in�omplctc and wil�he r�turned, It wi11 not bc reviewad by MCWp stafC unhil eottlple�
By sigzung this app�lioatiai�, [ �gnee and un��st�nd that thc Distrid� m�y �nt�r r,he prapc�ty ,�� r��n�r
hours fq condur_t art inspection to dcterr�inc wheEher ch�: terms nf Fhe permit arc being m�t. [ fvrt�;
understand'ih�tt iF I viol�.te the ternts and conditions of a permit (hat is issued bas�;d upor, tllis applieat�e
the �istriet shSll canduct��eid ir�sptc�ion oi tktt pnoject �rMCWU Ru[�f� providcd wiih tl'�is e�p�Iicatir_�
I undcrsfand the Dastrict will cl�rge fees ta�ovcr t6c actual oosts of fceld �nspectiQns, irtcl�ding invostigati<
oC the area af�eeted by the work,analysis of the work, includi�ig the se.rviecs of�c�al eounsel �nd en�ir,et.
ai�d any �ubsr,quenE manitering of thc work. Thc District's aetual costs arc �letmed �o begin aecruing u�,
the �istrir_F issues notiee of Ehe vio(atio,� lo the per•mit�ce. i ha„e ��aQ and understxt�d thc hiC`'Jt7 1'ecr�n;�;
Guidtlines fvr sar�dh!anketc.
—,�'! _ � � l
St nature o _, � �i6�
S pr'operry Uwncr [,lxtr �
Subseribad at�d swo+-n lo brfarc rnc Ehi� r�p oi� 200 r�..
` JUDRIi E,NICCUM
- • FbrqRr PUBLIc•�41►�pTA
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� pc�oved�nd Aerep[ed by
�n.�ni�� 70GfiT I 1.9TE1 ....�............. ..__.,_ ,_,f��I r�.._ .
TOTAL P.02