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MAR-19-2001 15 1�v,�4�+ �� MINNEHAHA CREEK LJATERSHED _ 61.24710682 P.02102
<br /> - :"11 I ° Ir111 INEFTCREEK WATERSHED DISTRICT
<br /> ate'"` _ I °.-
<br /> 'f '••'al•,4I Li_W.
<br /> I,?u kd�nSate.6 +
<br /> KC,A, .y Owner
<br /> Address City,State,Zip . ..c3.3
<br /> Qsa - 471 - g 188, 41(,..„—
<br /> .6 PID 21- t 17
<br /> Phone County Township,Section,RangeZ
<br /> i'�8 (from grope tax statement)
<br /> own and ocrupy the above single family residence and wish to install a sandblanket on
<br /> VI 41e.,a. - 1.,Tuo,. )3R 7
<br /> Ulm&Bay
<br /> p0 I have contracted with e 0-1\
<br /> i e -s a,Y.�l a chat 3/-3 �,,,�,a J. —
<br /> o`.--� � S : contractor address
<br /> `_ __,, 9 se.412- I I g to install clean sand from the following source:
<br /> city,state,zip phone
<br /> ) 11 e ecn S w„,.ci4,
<br /> supplier address C...)144)4.4 , 4y 8 -417 S or:
<br /> phone '
<br /> ❑ 1 will install the sandblanket myself from the following source.
<br /> supplier '
<br /> :mums—
<br /> phone
<br /> -
<br /> phone
<br /> If this project requires municipal approval or review,please attach documentation of the municipal approval
<br /> with this application. My shoreline is 1 oo+ feet and,the dimensions of the proposed sandblanket are:
<br /> --S° (Length) x I 0 (Width) x C,< (Depth).-
<br /> Sandblanket dimensions cannot exceed a
<br /> length of 50' (or 50%of shoreline),a width of 10'and a depth of 6".
<br /> I understand that if this application is not completely filled out, or if I fail to submit the required exhibits,
<br /> the application is incomplete and will be returned. It will not be reviewed by MCWD staff until complete.
<br /> By signing this application, I agree and understand that the District may enter the property at reasonable
<br /> hours to conduct an inspection to determine whether the terms of the permit are being met. I further
<br /> underatartd that if 1 violate the terms and conditions of a
<br /> the District shall conduct a field inspection of theproject per�nit that is issued based upon this application,
<br /> per MCWD Rule J, provided with this application.
<br /> I understand the District will charge fees to cover the actual costs of field inspections, including investigation
<br /> of the area affected by the work,analysis of the work, including the services of legal counsel and engineers,
<br /> and an subsequent monitoring of the work. The District's actual costs are deemed to begin accruing when
<br /> 7. - 1. 1- - ti •;-« • . : of the violation to the permittee. I have read and understand the MCWD Technical.
<br /> u 7 rr Pt • . els.
<br /> Signature of mPeery owner Af1,4
<br /> l Z� z.,p
<br /> Date
<br /> Subscribed and sworn to before me this I omaC day of It•Ap,,c,e.9 D 1 .
<br /> C',--7-- ,,A(S.0--Y",'I'A-(1 i,('6 " �i"+,i:� JULIA M.RAIDER
<br /> "' a a"' NOTARY PUBLIC-MINNESOTA
<br /> Notary Public
<br /> ;�R;w};1 :
<br /> ;:I��". My Commission Expires 141-2005
<br /> A2 . .ed == ,,("4 Accepted by bra 0
<br /> Ia es HAfner. ilicir;n} Te 41ran;A„ Date
<br /> - - ----- . . .,
<br /> Tn-rni
<br /> -- -
<br /> TnTni 0 0-1
<br />
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