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HomeMy WebLinkAboutMCWD permit _THIJ-1'=+—��=.n=u=� 1��4� f�1IhlhlEHHHH i:.F'EEI:; I:�:IHTEF"_�HELi �.1�4�1�=tr,=,� F'.G='11:•`'G11 ' P�llT�f�lci�AFiA C%r'�Ei{ WA�-E�tSr�f��E> ��c:,'1"FilCT' �IA� 1 3 ���k� permit # DO- UG�� SwpR ���}�` DM , i�IT�CTION��AST TRACK PERMiT ��4� r...� '�7, . �i_..� ,.,.,. �.., k .. � V1..,. t,� ,,,e„ . MINNEHAHA CREEK WAT�R�H��l DISTRICT GRAY �RESHWATERCENT�Ft Ph: 471-0590 2�00 SNADYWOOQ RODD FAX: 471-�68Z , EXCEL�i�R, MN 553�1 Q,,,,,��.L Q �- �o rs � �, �� ��,1��- reside at �'�'��`� � . 1�ak�. �� . (Prope�ty Q'�vner) {Street Acfdress) l_a-n ti-,4..\s� , �=�m SS 3�� , �1'1(0 � aa4 3_ request approval to ic�stal� �Cit (State) (ZiP) (Pl�onel riprap shar�line �rosion protectian on praperty described as �a..,M-.� , Idcat�d in (street �ddress) � _ , o� - I �� -�.��� oa�� - Tf�e �ip rap inst�ll�tion (Within the City b4undaries} (Counky) (PIl7#) wil{ consist o#..,�� - alon� tF�e shorekine of � , `��-���� in fulf {lineal fEet) (Lako) (B�)') accordanc� witfi the Minn�.haha Gr��k Wat�rshed District Shoretine Pratection �uideline far riprap placement requlred f�r issu�nce af a Fast Track �en�ral I'ermit. I have contracted with � CO�IC�PT LANDSCAPING , , � �� "� (Address) (Phane) ► c,,, , to perform the wvrk who is fami�iar with the t�chr�ical requiremet�ts {Bond mber} and h fuffil d banding requiremer�ts af the watershed district (s�� reverse). i have r�ad arid,ri'� er n e raquirements of t�e MCWD elating to Shareline Erosion Protection. r � �` ! ��Y�� �g;� �a wner) . (L7at�} Subscribed and swo�n to ,►efore me on this �?t�' d� of �r _ , 2000 Y �,.__�.. --� r r� �1 � �:;".=; JAM�S 1-lAR4LD SMfTI-1 ` "` \ NOTArY PUBUGM��h�ESOrp � -�/`(1'`�"--' I ^'� �' �o�;�;k� MY CpM1A15$ION F�PIRE51•31�1 Nota Public : �✓ ' �_.�..... � � -• �� Approved Ciy; � ` ��- Date: / � p� , � Distributian: TPr�pe�ty Owncr _Contractor _Muqicipality _�7NR _17istritt File TLiTHL F'.G11 L�E� : �'-1'�'�'�+ 1�'�GZ�i f l I IdllEHHHi=� i_F'EEI I,.IHTEF"=�HEL:� r�1�-��1�=1�=�� F'.�=�1.'�=�1 St�N�7Br,AN�T P�RMIT & SAND SOLIRGE ��T�Z'I' �'��M MIZViVEI�AHA CKEEK '►�VATERSHED ].7ISTKTGT _ PE�T 9� � `�`t-24E. I,�aY'�t 1�17�C��{°� residi�l� at �'� �,� � . �.0.k t ��" , 0 5��'� �� FroExrty Owtier Address City,State,7.ip �_�� ��a.4 3 i��.v� , or �'I�#�.5 11J1 �� �� o o W`f �hOne Lounh� Township,Secttian,�an;,e ((c�m prv�perty tax st�temcnk) oti�n ar�d occupy the abo�re sizic;le family residence az�d w-is�l to iiis��ll �.sF�ndblanket or� M����t �rt"�P.��� Iake&Say - ----- � I �ave contrAe�ed �rvith ��N�CEPT LANDS .APIN , At —��r�t�i�l�ST LAt�l� nd�irrss MOUND, MN 55;�64 fo insi�ill clr.�,n �i.nd ironi iitc: following saurce_ c:iry,statc,�ip phonc � .�--��=�+� '`J 4.r`x� �.:t1�� , ��g �� �� � � or: 5 Ll��lLlC2' A S�ICS$ �7}IOriC ❑ I �vill install tlle sandbl�nket myself from t]ie followin�l� SC71IY'C:C. � - sup�lier -- --- - � - address phottc. If this project requir�s tnunicipal �pproval or revie���, pleAse attach doctintientatio�i of the munic�iphl �ipproval with this applicatiori. 11�y slioz�eline is `�� feet ��nd tl�e di�n�:ttsians of the �,r�,p�,sed .s�ir:idblanket are� �7 1��� (Lcn�-E�rt) �c �Q__ (Width) :� � (Deptl�). Saildblanket dime�Isionw car�nc�t excee�l a 3en��th of 5�i' (oz• �D�% of shc�,�linej,�, width oi� 1�' and � dupth of 6". I ix�ic�ct�stanc� that it� tlus application is r�ot complete�y fi��ed aut, or iZ I f3i1 to submit the required ex�tibifs, thr ap�alic�tiot� is ixicottiplefe axid will be returi�ed. lt w'ill iiot L�e review'ed }�}' MC�VVL? staff tiiltil ��om��lt:t4:. ]3y 51�211Y1� t�'l1S ap�licatioii, � :��rc�e. �nd understand that the 'L�istrict ni��y cnt�:r t��t: pmperty ��E r���a�c�n���>lc� l�ours #o conduc:t an ittspr.ction to detcrtninc whekher tllc #erms af the. p�i•mit are �7ein� meE. I furtiler• ur�derst��r�ci t��at if I violakc the fertn.s and cot�ditions of a ��erinik thaf is issucci baseci uport this a��plicatiofz, t�t� Dlsttict sltall cotldLict a �ie.ld ir�spectiott o� t}�e pr��je.ct pez' aVICV�D Rule i, ��rrnrided ��-�111 tl,;� af�plic�t���+tt. I undersfarid t}ie: L�is`trict wil� �.har�c fces to c�ovcr tl��. a�tu:�l ��osts o# ficld ins�e�tions, inc:liadinh inv��tis�F�ki�n of the are� affeete.d by thc w��rk, analysis of khc wc�rk, inclrxc�in�; the sc.rviees ot' le��al coun.5e1 a}ld c:n��irtce:t•s, tin�� ��ny suE�si: c:rtt tnonito����t� of the work. Tltt Distri�k's �ctual cosfs �rc dc=czi�ed to bc�in ac:��ruizi� w�ic-n thc: Di�tri'� � _ es rtotiee �f tltG vic�latiotl to the �>ertttit�ec. I h<�v�' re.�d <�r�d �and�:r�;tand tl�c M�'1�rU '1'i�c•�1r1i��a1 �ui`c �' i�T .)al1c��?�clzlkct�. � � �� � � -'_,� '� � �. l L/ � � Si�rtatut�c of propczty o��rnc Dafe �� Sut�sc.ribed .and sworti to be.fo�,c zne thi� /''� �- �y of L�. a.c�-�1�� `� ■ r F � � ^. � JAM�S HARaLD SMITN r,: h ��e . - _� � ;,,,;,_ / r�arnav Pueuc-aurn�sar� � ��7�'-� / ������ rar c.o►�nss+o�a�xai�s�.�apoa � � t�lc�tar_ r�u.}aliL . . „ �IL: % a` ; - �':� `�"` /7 �� " � ------- � 1l� .rovc� and I�c�ce��ted by L�atc� � � .)atncs Hafnc-r, L�istrict Technic:iarl ::3ndl`-`nt�r�a�; �_ _ ._ TOTHL F'.�-�1