HomeMy WebLinkAboutMCWD permit JUhl-26-2b�i�� ��9:45 f'1I hdhdEHHHI� (�'F-'..EEE<; I.�JHTE�:SHED r�1�'4�ic�r��,� F'.�_��:•'Gi:
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Pefmit # 00• � ��"�.
$HC)RE�.lJ�E EROSION P�l�7ECTI�N-F'AST YR,�4CK PERrVNIT �
Nl1NN�i�GqHA CREEK VtifATERSM�p 1]l9TR�C�'
GRAY Ft��HWATER CENfiER ph: d7'i-0590
2380 SHADY�l1iQ4D RO00 FIe,,X: 47i•p8$2
EXCE�„SIOR, �AN 55331
1, - �asid� �t ��C;3C � �"�,{�--.��-7 �-..�-���.
{prp�rly Ownery (Strv#t Aadr
����D , �� , ,Z` � l�quest �ppl"ti1��l ta is►atal!
(Clty} (St�ls'r (Z1p} lPhan�}
riprap shoreline erasjer� protec ' fln pr�operhr described as �?���i���'�"L�rlocated in
� �l , ��' ,�8�1`l�'� r tstraet ao e r��r�
p p inst�Uation
(vYthin tt�e�i undarles} C.ounryy (PID�)
i
will ronsist af,�S�D �I4ng the shoreiine of (� ��.7� 3 irt fyll
tlinesr tee<) (i.a�ce) {8ay)
��or�ance with the Mi�inehaha CrQek Wat4��Qd QistrlCt�h�rel�t�e PrOtaCtiOrt Guid�ilne for
�iprap placement required for issuan� qfi a F�st Tra�lc�ert�fa[ Permlt. I hov� cpntr�cted with
� � 1 �` ,.�79C� , Y�'7�,���_c.-� ��r� �l 7�—��3� ,
(Neme of Company) (JqddteSs) (Phon�) -
s� �3��� , to p�rfcxm tha war�t who is famfliar with the#�ch��tak requirements
(Bnnd Number)
and �1as ful�ii�d the Don�ing r�quir�m8nts �'�thewa�c�hed district t��e reve+�ssy. i have read
an� �s nd #he quir� Of xh8 MCWU r�Iat��g to $ho��Iir�e E►osior+ Protgdiqn.
��
gnat�re roQe Ciun+��) fo a?
Subscribed and �wom ta�fofe me�n this I 5�`'„��,� �� , 200�
■
SN�RYL A.LATT�f{NER
�� �•-�1
MvCOMM�SSIO��X RESi�,�p06
Nt�tar,r Pu �c ` ' .
� APRroved �y: aate: �+
�
ouen �„ e,P�+++r .. _ tor ume ty _ N� _�+.tri� �R
" MiIVNEHP,H,4 C;F;.F.CK.
VYN1 �RSH�f:� C�1S:TFiI�:�T
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Ti=iTHL F'.�=r�
JUL-05-2000 10�59 MINNEHAHA CREEK WATERSHED 6124710682 P.02i02
WaTEF1wF1=�, ���TI�iC"f
S1�IVDSLAIVI�T P�RMTI' & SAND SOURCE�iIBY'T Fd�.i111'v 200�
� Nf.� CREEIC WATERSHED DISTRICT
--,�'�.��,��Y
_ �'���
1, „� b � e�
D 8l� R 1 7` residittg at ��l3�n � , bro�o ,�,5�,4,5'3�/
F'roperty Owner Addcrss City,St�tc,Zip �—
( � 7S��� . l�•/e�/N , ��1'DYJ/� or PID#O�117�39�D�
Phone County Township,Section,Rsr�gc (from property tax stiilqmcnU
owtt and occupy the above single family residence and wish to install a sandblanket ori
Grys�1 a�, �r��3
Lakc&6ay •
� T have contracEed with �s' �,��7� at_,37/�'D �.P��(�J 6�aY��
contrxctur addrrss
���S%D/' �N SS� ,3�, ��� -79,�9 ta instaIl cleah sand from t�tc following s�urcc
ciry,state,zip phonc
�_t�'� 1�1 v����t �31 �a�� �c/� %�zh'1 �Jv�'� , J �o . -�76zo or:
su�l,er adcl�r.ss plioac �
❑ f will instdll the sandblanket myself from the following sourcc.
' su},Pt�cr .�
^�> >
tic�es s phonc
If lhis project rec{uires municip�l app.roval o�^ review, plefl.se attach documentation of the muriicipal appmv�:
wil�h th.i,s applic:ation. My shorclinc is�O� feet and lhe dimensions of th.e prppos�:d satic�blankef arc:
ii
�D/ (Length) x �� � (Width) x�,�,_ (UeplFt), Sandblankc;l dimettsions c�.nnol exceed a
length of 50' (or 509ti of shoreline),A width of 1.0'and a deptl� af 6"_
I undersland tha.t if this applieation is not comp�etely filled out, or iE I fail to subm►l lhe rec{uired exhibit;
the appIication is incomplete and will be rcturned. Il will not bc: reviewed by MCWD staff until complelc
Iiy signtng this a�plication, I agrec and understand that the District may enter the property a[ rcasonahl
hours to eonduct an inspection to dctermine whetk�er the terms of the permit Are being met_ I furthe
undersiand�that if [ violatc Ehe terrtts and conditions of a permit (hal is issued based upon this applicatior
the Distriet shall conduct a field inspzclion oF the project per MCWD Rule f, provided wiEh this applicatior
[ understand the District will charge fees lo eover lhe �.ctual costs of field inspections, includin�; investigatio�
of'thc; area affect�:d by the work, analysis of the work, including the services of legal counsel and engincer:
and any subsequc,nE monitoring of the work. The District's actuai costs are deeme:d to b�gin acc�liing whc�
kh l�istriet issues notice of the violation lo thc> permittee_ [ havr; read and uttdcrst�nd thc MC:WI) '!'eehnica
G de nes fo san s:-
� a�-�
$ig ature of p perty owner �a�.�
Subscribed and swortt to before me this �da of�-+'��C- 200.�+
� SHERYL A.I.ATT�qNER
Q , NOTARY PU9UGMINNESOTA
MY COMMIB�ION E7CPIRE61-01,ZG06
otary F'u Iic . . . � . � �
� 6 �_
Approved a d Accepled by i�atc
James Hafner, District Teehnieian
TnTAi P A�