HomeMy WebLinkAboutMCWD permit JUN-19-2006 14�59 M C W D 952 471 0682 P.03iO3
Permit �0 , �Z
Sandblanket t�ermit and Sand Source Exhibit Forrn
FAST TRACK PERMIT
MINNEHAHA CREEK WATERSHI=D DISTRICT (MCWD)
18202 MINNETONKA BLVD. Ph: 952-471-0590
DEEPHAVEN, MN 55391 Fax: 952-471-0682
I, reside a�t�/7� ��Cd / � ��" , ��'C��f�
(ProDe ner) (a,ddresa) (City)
, .Q����-��L�2 request approval to install a sandblanket on property described
(State,ZI ) �,(Phope) �
as�" y r) �n,�n..-/ �'J , located in �I�C�v , 'l.
(Street address) �thin the Cily boundaries) (Coun )
c'�U"ll_7_�3�31-�o��o� _�
(Properly ID#[PfQt�]) (Lake) ( ay)
I have contracted with�Y k�(,.Nr�%9"�Y1C. ,4�� ��To<�l �Q�(l i 0 .
(Nam�of Compeny) (Street eddreea)
Il.f IJJ ��� , (�J�✓11 5,���_,_,_,_..,.to install clean sand frvm the
(City,Stato.Zlp) , (Pho .
following source.�,�._a��-�'1� _— �
(Su�rfier) (Address) ( ,Zlp)
(� �IID/-��C�
(Phone)
I will install the sandblanket from the fnllowing source ,
, (Supplier)
, U
4Add�ss) (City,Ststa,Zip) (Phone)
My shoreline is 1�feet and the dimensions of the proposed sandblanlcet are; �X
(Length)
'� X � Sandblanket dimensions cannot exceed a length of 50' (or 50%of shoreline),
� epi � t .
a width of 10' and a depth of 6". If this project requires municipal approval or review, please attach
documentation of the municipal apprc�val with this application.
1 understand that if this application is not completely filled out, or if ( fail to submit the required exhibits, the
application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete. By
signing this application, I agree and understand that the District may enter the property at reasonable hours
to conduct an inspection to determine whether the terms of the permit are being met. I further 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 of the project per MCWD Rule J, provided with this application. I understand the
District will charge fees to cover th�? actual costs of field inspections, including investigation of the area
affected by the work, analysis of the work, including the services of legal counsel and engineers, and any
subsequent monitorin9,of the work. Th District's actual costs are deemed to begin aceruing when the District
issues notice of,tk��e:,�"ol tion to. [C��e_.I have read and understand the MCWD Technical Guidelines for
sandblankets- _ ,;—�" 5 �� O�
ature of PropeR er) (Date) � � II��
Subscribed and sworn to before me un this��day of f.� , �
�� � SHERYL A.LAT1'ERNER ��r' O � 2006
Notary Public NOTARYPUBI.IC-MINNESOTA
�„ My Commla�lon Explra Jdn.81,2010
.�:
Approved by: `��~� Date �� �q ��
TOTAL P.03