HomeMy WebLinkAboutMCWD permit APR-30-2a07 15�56 M C W D 952 471 0682 P.02i02
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Permit# D� - l v 7
Sandblanket Permit and Sand Sourc� Exhibit Form
FA5T TRACK PERMIT
MINNEHAHA CREEK WATERSHED OISTRICT (MCWD)
18202 MINNETONKA BLVD. Ph: 952-471-0590
DEEPHAVEN, MN 55391 Fax: 952-471-0682
�,S��j �� �'�H�\ _reside at ���� �\)� _�-� ���rc1`�� ��� t r \l� "�.
(Prope��lY Ovmer) fAtldrEss) ���ty)
� ^ , (�__ request approva�to install a sandblanket on property described
_ (,late, �p) (�hune)
a5��_{`,-,�e;;�l� �r ir��,{,.�,LL� _ , located in , _ , �f'o�.v
(Street add�es�,� (Wilhin Ihe Cily boundarie.) (County)
D7-1►�1--�-...1� -���,I�'a on 1�\�d�Y�e_�onV.�l. �t�re._� � �Ar�rr��
(Property IO#(PID#]) (Lake) (Bay)
I have contracted with�����`r�,r-��r�,�{;-�('E�, � c'`� < ���1
(Nhrne of Campany) (Stree�adCresg) �
" � � , �I� ;��—�L�� to install clean sand from the
(City,3�te,2iP) (PhonG) � 1\ �
folfowing source � . ��
� �
p er) (Addr�ss) - (CnY.21p� -
��$) '�
• (Phone)
I will install the sandblanket from the following source J �f`�,
� (Supplief)
�k�Z��. �c�rn�t�►,�QI,�`���irhn��e�,�1t� ����.; � �,y --�C�a
(Addross) (City,Sf e,Zip) (Phone)
1 �
My shoreline is��feet and the dimensions of the p�oposed sandbl�nket are: r X
�/� (Langth)
X 1 D r , Sandblanket dimensions cannot exceed a length af 50' (or 50%of shor�line),
( ep ) (Width)
a width of 10' and a depth of 6". If this project �equires municipal approval or review, please attach
documentation of the municipal approval with this application_
I understend that if this application is not completely filled out, or if I 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 pe� MCWD Rule J, provided with this application. I understand the
District wilf charge fees to cover the actual costs of field inspections, including investigation of the area
affected by the work, analysis of the work, including the services of le�al counsel and engineers, and any
subsequent monitoring of the work. The District's actual costs are d�emed to begin aceruing when the District
issues notice o' olatiori to permittee. I have read and understand the MCWD Technical Guidelines for
san ' C � ,���
(Signeture of Property Ownar) pj, � D t
A is,_�day of , 20�.
- ota f �4 �� : �,�, , �
N�q �ip��n Expires Jan,31,2010 � �� ( � ' '
� �� �:1
Approved by: � pa��R �� o
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TOTAL P.02