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