HomeMy WebLinkAboutMCWD permit ze'd �d101
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MINNE�IHA CB.h'EK WAT�BSH�:D DISTgICT
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Property Owner . Addncaa City,Stafe,Zip „�S'���
�.5�-�17/-/0 3�. f��i✓� , or P1lD#� //7�3 - /Y--GY�,L�
Phcnc Cbtttdy rCowemiup�Sed@on,@et�gc i��P�'��iy taa state�cnU
own and ooaupy the above sit�,gte fsettily residenve and wish to ins�ll a s�dblanl�t on �
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l�.�ae ae B.y .
� I have cantracted with MinnEtonka Portaa►� Dr��'�.;i��g
eo� @S • adA�esa
,�g to install ele�.n sand from the fol�owing sourc
c�sy,srnt�,zip phone 4�49454
�dL�l• 1�i,<<�LLl��q�S,Or/ ����y� ,r`ItJi , � ,oC:
suppliv eddrras phonc
❑ I will install the sandblank,et myself fsnm the following sourcc_
supputr
� addrrs,a phonc
IE thcs prvjecE requires municipal eppmval ar review,plea�e aitach documerttation af the mu�icipal appro
with this appticatian. My shvreline is.,,��_fcet and the dimensions of the propos��d sand�lanket are:
S'D (I.ength) x �1� (Widtl� x____�� (ikptla).Sartdblankct dimertsianx cane�ot exceed a
lcngth of SO' (or 5046 oF shoreline),a vNidth of 10'�nd a depth of 6". �
I unde�sE�and that if this appli�aEion is not compleEely ftlled out, or if I fail to subtnit the r�uired exhik
the applic�ion is iaoomiplete and will be t�eturned..IE will rwE b� rcviewed by MCWD st�.ff until eompl�
By s�g,cti.�g thia applioation, I agree and un�et�sland that tlie Diatriet may enter the pmperty at reasons
hours to con�duct a.n ir�spection bo detertttitte whether the terms of the permit arc besng met� [ furt
and�rstand•tl,�t if [ viiol,�te tlu terca,s•and conditi,ons oE a perniit tk�at is issu.ed based upon this applicati
the District�tall`oonduct a field in�speetien of the projcet prr MCWD S.iuie f, prwided with this applicati
[undcrstand=thc Disiric�will c�sargt fecs to eavex the actusi costs of feld inspections,inc.�udir�g investi,gal
of thc srea affec6ad by the w�ork,analqsis af thc�work, includin,g th�serviae��i caoan�el and engine
and any sub�uerf moniborir4$of the wurk. Thc Dist�rict's aeiva[oosts are dee to begin aecruing w:
the DisErict �ssucs notice of the violakion to the permittee. [ hav� read ar�d understand thc MC1NQ Techn
Guidelines for sandblsaket�.
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Subseribed artd sworn to beforc me this �v day of �"� .200 02!
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����� TERESA M. KES
c�.G�� �' Notary Public
'i� Minnesata
IVoEary Pu61ic � ..,.,-���:.,.' � �* :
My Commissl'on Expires Jan..31, 20 5 �
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Approvcd and Accepted by Datc
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