HomeMy WebLinkAboutMCWD permits JIfL-14�200.3 15�12 MINNEHAHA CREEK WATERSH�D 6124710682 P.05i06
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SANnB�.A'�`r`�!��t1VIIT,& S�ND SOt1RCE EX�-IIBTT FORM� .
� CREEK VITATF.�.SHED DIS1'RICT . '
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l, residina at c��11,�',� �.� A �/!'l„��
Proherry Owrier Addnrss City,9�te.7.ih
�Q �' f�'��� ,,�N!'� or P1D#11 Q-1�1�-.,2/-ed/
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Phone GOunly Township,Saclfon,�:18� �R+P�P�R'7 ux sialo�t�cR1t)
own and occupy thc above sir�gle�am�ily�eaidenoe �n,d wish to instal�a sax�dblar�kret on
/�1�- rI'I�x�o����.
��s�,
Minnetcnka Portable Dredging
� I l+ave oontractrd wit� at
`°�sior� MN 55331 to install cltan sand fcom the following sou
eltY�s�te.aip phone
/h,�•c.c�e b►��./ �i�ti�i3ue� 112iv. , S��`' �11 ?S ,or.
���s��� '— s�deess p�+o�+e
❑ I will ie�sta�l the sandbl�nlxt mysclf from the fellowir�g�oura.
. �pptier
addresc - ---- -- phone
Yf this pz�ojecE requixes �nunieipal approval or review,plc�se a�tach docutnenEaliop of the municipal appc
. with this application. My sho�eliY►e is � feet a�nd the dimensiot�s af the propos+:d sandbla.nket are:
,�(Y.ength) x �.,,_ �idtk�) x� (Depth).Sandblank�t dimension.c can�et exceed. a
letlgth of SO' (or 5096 of shor�line),a width of 10'and a dcpth of 6".
1 understarid that if thi.s application is not cotnplcteLy filled out, or if i f�il to submit the renuired exhi
tlte applicatioti is incomp]�ete end will be ketu�acd. It will not bc reviewed�by MCWD staff until eomE
By signir�g this appliration., I agree and ur.d,eex�tand that the District may ent,er the pcoperty at reasor
hours to corduct an uupection to defermine whetker the terms af the permit at+e beirtg met. t fut
unders4atud'tha! if I �iolaee the k�cm„e and conditions oE a p�rmit.that ix issued b�sed upan this applica
tha Distriet�hall e.onduct a fiedd inspcction of tlie projeet per MCWD R,ule J, provided with this app].ica
t understand tke Distt'►et will el�axge#ees to cover the actual costs o�field ir�specliox�s, in�luding invutig�
oF the araa affected by the worlr,s�ysis of the work, ix�cltiding thc services of le$al oounsel and eng��n
and any subsequent monitorir�g of!he work, The Distr�i,ct's actual cas�s are deetned to begin accruing +�
tht Dist�i.ct issucs notia of the vio(ation to the permittee, I havo r�ad and understand thc Mc:WD Tfch�
Cuidelines fo sandblanke .
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S zr Date
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Suhscribed and sworn to befo�e me this day oE � 200� �
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� /a TM_ SUSAN NOfiN A : i�.� � �►
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Nata. Pub[ic . .,.,,.t�;:��, ` . ;S
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Approvcd and�►cccpted by Oa e
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se•d 6e:9ti �0ez-vi-�nr
1lIL-14-2003 15�11 MINNEHAHR CREEK WA7ERSHED 612d710662 P.94i66
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SHORELINE EROSION PItOTECTION-FAST TRAC PEitliAlT
MIHNEHA}lA CRErK WATEIZSH� DISTRIC? �
. �iAY FREStNrA7�lt C�'IFR Ph: 471-OdAd
2500 SHKO�IWOOD ROOD FAX:471-0�2
EXCLL�IOi;MN 55331
I,ST�� r reside at ��bs •�im,c,E �iP.���ea GJ�,
aenyow��1 �s�-�ere�sa)
A�� ��s 3�:fj _.v "� �a�8'�' 1'e�ue�ap�xOVa��o InS�n
c�i► cs�) c�w� c�� �'_
�steor.w�e�vwon peo�fot�a�woperby de�cribed as . �oc�in
�, �,[��.v1� , . �5,✓.r.ti , Q9-//7-�'.?i��he rip,rdp installstlon
lwa���r���I <�+�+h►f l�f -
w�l oonsi.st o�,1,�aiong the s�wreline ot I'���,�t�1t �J�i?�X,�.�rzr,L- in fi�ll
A�+�� t�) . t�►)
aooad�r�oe wah the M�ha Creelc wa�hed D�biK:t Sho�ne Pro�tec�ion Guidef�for
, �1Vlinnet��nka Po���nlssuano�e vFa��Tiadc Qeneral Pe�nr�I henra con4�acred wlth
500 VVest Leke St , '
�'��i,'�t � U��) ��+a+e)..�,,
474�9154 '�
'm perfo�rn 1he worlc who is 1�mt�ar w�h the technic�l requi�+ems�rf�
(Bond lW�r�6�r)
and h�fuli�ad 1he bondfig requHemenL4 of ihe w�ed district(see reverse). I heve nead
and unde�rd iha r�quirern ofthe ,�IA�11VD rela�nA io�ot�r�E�osion P ' .
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Subs�xibed arid swan io before me on this day of ' • 2002
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• • SUSIW HOAN
�`y='• MORA��U R+eiJGMh�MID6���
N�ry waarw�o�+m� .
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Approv�d By: �� ...�..�,,,�,_��_ _ , Date: l��
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`7�� JUH 81 �
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