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<br />,o,p.....:c.ot... <br /> <br />RICS CREEK WATERSHED DISTRICT <br />,SL}ITE} 77, ARDENPLAZA <br />3585 NORTH LEXINGTON AVENUE <br />ARDEN HILLS, MINNESOTA 55112 <br /> <br />Ce-: ~ l>1NMflJ~~ <br />2 A ~eJaJz..- y~ , <br /> <br />r<.c..wDF <br /> <br />(For'Office Use Only) <br />PERMIT APPLICATION NO. g4 --/33 <br />Rec'd Office I/-/-S'f Rec'd Engr. <br />Notice Sent II -'5" ~Lj <br />Agenda II -..2 &' - '?vi <br />Administrative Fee <br />Inspected. : <br /> <br /> <br />G~OV = 71984 <br /> <br />tI /0"" / WwJ4!I~dr3 <br />SO;;J..1> '. <br /> <br />PERMIT APPLICATION <br /> <br />To be completed by the applicant <br /> <br />Owner: <br /> <br />lA! IN F lE-LD (:{;vf:L-OPMeNTS Date: <br />!fISO l,..INCDLtJDRl"E::- Telephone <br />~DII'J'A-IIv~ N .' .S"'5lf 3fc <br />(zip code) <br /> <br />Address: <br /> <br />Cityt <br /> <br /> <br />Permit Application for Approval of: <br /> <br />[]~~~~:~:~~i;~a~tormwate~ <br /> <br />~ Land Development Plan <br />Final Site Drainage Plan <br />...... Use and/or Appropriation <br />of Public Waters <br />Bridge and/or Culvert Construction <br />Wetland Alteration <br />Shoreland (Riparian) Improvement <br />Private Drainage System <br />Individual Sewage Treatment System <br />Other (explain in remarks) <br /> <br />Remark.s: <br /> <br />Name of Project: <br /> <br />N E:v0 P)R i (. H T 6 ""-'l <br /> <br />Purpose 9f Project: <br /> <br />Location of Project-Address: <br /> <br />I"1r <br />-.>::> <br /> <br />i COvNT'( RD D <br /> <br />,- ,: -~."_ .. -,'...1;/..'--:' <br />; .:..._-...., ".....".>'" <br />( ~,w. Q\JAO~NJJ~ <br /> <br />Municipality .or Township: <br />l/4 of Section <br /> <br />Nt \AJ B R) (; tt To tJ <br /> <br /> <br /> <br />Revised <br /> <br /> <br />Township <br /> <br />Range <br /> <br />Call 483-0634 if assistance in completing this form is required. <br />attach drawings, plans and other data as outlined in "Rice Creek <br />District Permit Information Brochure, available upon request. ...Mail 01':}<>., <br />deliver this form along with a $10.00 administrative fee and appropriat~" <br />exhibits to the above address. <br /> <br />llA field inspection fee on this permit shall be charged to COVer actual' <br />relatedtoa field inspection including the invest.igat.ionof the area <br />affected by the proposed activity, analysis of the proposed Activity,. , <br />services of a consultant and in addition, a fee will be charged for eY,r <br />required subsequent monitoring of the proposed activity. II . M.S.A.>112..e~ <br />Subd.2. Applying for this permit to RCWD does.notpreclude/your appl!1. <br />for' any necessary permits that may be requiredfrotrlother, 9overnment.a}j' <br />agencies. <br /> <br />A8...78 <br />