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'=�EF'-.���-1'�'�'� 1�=�: 1'� �1IflflEHHHH �:=:REEI::: I::IHTEF"=;HEL: F1�4�1t=ir�;� F'.G_r�. G_t^
<br /> SA1VT���„A�IVI�'' �RMIT 8c SANI] S�JUPGE EX��STT F(��Vi
<br /> r►��1N��I.A CREEK V�A'TE�.S�� �7�5'�'KIG"I'
<br /> � ��uvuT9� - Z� fi�
<br /> , o � _ �
<br /> I��o.J �oL AJt��� residing at c�� 15 }��� � C.e�� 0�un ����t
<br /> .......
<br /> ��y awn�r ndar�-- -- ��ty,srdc�,z��
<br /> ��-=1-_���,.-- �""'�-. , � ol'PID# o��- I I�I "�.�- + Z. - O O'��
<br /> Phona . County Towns}up,Section,Range (from pmp�riy tux stnlcment)
<br /> rv!'^���)E H A I-I A f::*-i F E}C
<br /> pwxt and occupy t�e abovc siMglc £amily �residence and wis�n tc�install a sandblanket �'ft"- �P s��� ���:==�-����
<br /> �Y��-k� — �an..m�.�..��- SEP z � �99�
<br /> r.���s�say
<br /> ,_,f C01aCEPT LANDSCAP�NG r , ;:.�,. ��� �„ „ ...h ,,�,�,:
<br /> LI � have conh�cted wi�th �i�_PRlFISr �a[�„_„ a� �:..., �
<br /> I�lkI�A�NFkprMN 55364 adtt,ras ' " ._- �•,"�u�`g�
<br /> to instail cl�an sand fimzt� the following source:
<br /> city,statc,zip phane
<br /> ..
<br /> "Y��� �'-h a..����. , �1h�G_h�/7��, or:
<br /> � supplicr a�iress phone
<br /> I wili instaj,t the sandblarclt�t myself from the fullowing souree. _ ,
<br /> suppiier
<br /> � ---- --
<br /> +�dd�+�SS p6onc
<br /> If tlus project �requires munici.pal approval or review,please attach docutr►.entatia:i c�#'the municipal apprav'al
<br /> with this app�ioation. 1Vf,y s�t�reline is��d _ feet axtd the dim�nsior�s vf the propasc:d sandblanket are:
<br /> �Q � (.Gen�,th} x 1 0 � {Widt�t) x . . (o " (C7epth). Sandblanket dime�sian�cannot exc�cd a
<br /> Iength of SO' (or 5096 af shoreline),a width of 10'and a deptll �f 6".
<br /> I understa:ld thaf if tkis application is not campletely filled ou�, nr �i� I fail to submit the ret�ui.red exltibits,
<br /> the applicatian is incomplete and will be retuxFtled. It will not be reviewred by MCWD staff unt�a co:rnp]c>te.
<br /> $y sigx►.xng this appl�cation, I agree and underst�nd tktat the Di�'trict may enter tkte prapc:rty at reasonai��e
<br /> hrnurs ta conduct ar� inspcoti.on tn deiermiree whether tlle terms of the: pea•mit are being tttet. I furt�ier
<br /> understand that if I violate th� terms and catldiEior�s df a pex-xnit #hat is issued based upor� this applicatic�n,
<br /> the Dxstrict shall eonduct a field xnspection o€the project per MC:wp Ru�e j, providctd v,rith tk�is ap�licatxon,
<br /> I undexsta3rtd the I�istrieE will ck�arge fecs to cover tk�e actual Co�ts df field inspectior�s, includin� investi�ation
<br /> of Ehe area affected by the wark, �nalysis of the woxk, includin� the services af legai cauxise� at�d engineers,
<br /> aiyd �ny sub,cequent m�nitoring of the worlc. The District's actua! costs are dcem�d to beg"in accruittg whe�
<br /> the pistriet i es notice of the �ioIatiael ta #hc permi�tee. i itave rrad �.nd understatYc� thc MCVITr7 'I'ec}inical
<br /> Guideli�nes o sandblanlcets.
<br /> Sign�t of property own,er Date
<br /> sub.scribed and swo� ta before mc this a 3 day of�� 419 4�; +
<br /> l�'" �' . , .�
<br /> �� JAM�$4iAR�LD SNfiTti
<br />` y Z'°" •� MORAAY W18L1G�NES�TA
<br /> Not xy Ptxblic �40�"��,a�� . .
<br /> ;� ,
<br /> _ ` ' " r��k/��,
<br /> . �. .,,_,,.— �
<br /> App ved �.�nd �1�cepted by �ate
<br />,Jarne's Hafnex, F.�istrict Techrtieir�n ¢owII7 .AAhr a�
<br />
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