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f SHQR�LINE ERaSfON PRQTECTfON-�AST TRACK PERMIT I
MINNEHAHA CREEK WATERSHEQ DISTRICT
GRAY FRESHWATER G�NTER Ph: 471-t7590
2500 SHADYWOQD I�OOP FAX: 471-0�82
EXCELSIOR, MN 5533�
r�ac�
�� ��C ����--�reside �t_�_�0 C� ��f O vl ��,�-�-�--'�� '
(Propert}� �ner) ' (Strret Address)
�'(� 1_ 1� �� t , _ {�� ����'�,7� . «que5t ap}�rov�l to inst�ll
�. �
{�ity} (State) (7_ip) (Ph�ariej
t (��
ri rat, shoref�ne erQsion protection on prope�ty described as�3�I� �r S�-4 �, �o��tef.� ir�
� F-' �SfCZe1 �3 �.r?`ia�
, �
. Yhe rip r�p installdti�n
(UVithin the Cily bound�ries) � {Cour�ty) {PID#}
wi![ consist af �(� '�long th� shor�line of��'v��-'s'+, � �n full
(lineal fee#) (Lake} f���y)
accordance with the Mi"E�eh�l�� Cree�� V'Jatershed District Shoreline Protection Guideline for
ri��ra� pl�eement requi� -d for issuance of a Fast �i r�ck Gen�ral Perrnit. I have contr�cted v��itl�
��� .. �._
�a (Narrie of Company} (Address) (Phone}
� 2� �, to p�rForm the wark who is familiar with the technical requirements
(6ond Nur��ber)
and has fulfilied th� bonding requirements of the �rratersf��d district (see re�•.Jerse}. I h�ve read
and unders nd the requireme�ts of the MCWQ relating tQ Shoreline �rusion Protection.
�-� ��a
�' (D��tej
` (Si �ati�rF �f Pro e wner)
Subscrib�� anci sworn �a before me an this�� ��� +��y �f_,,.����� ����
/' ^�� �
r
�v_�1�._ - - /, � SAN�RA LEE KEt�]T��LLY
Jotary Public \ t� NOSARYPISELI.r.-MI"INESdTA
C µy ppMM�s5�0�+EXCIf�ES t�7-aGDS
� � �—
Approved By:
��� Date: t 3 d/ i
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�i���� _prn��rt-v[)��nzr _C:oniraclur _ Municipalsty _�Nlt_ _District Fiic
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