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<br />"WI' ' <br /> <br /> <br />':~^'c":'_:;ll'~~~':~tI~'f;.p.""",..,..",,~ <br /> <br />I <br />RICE CREEK WATERSHE~ 0 STRICT <br />SUITE' 177 , ARDEN P~ Z~ <br />3585 NORTH LEXINGTO~, A'J <br />ARDEN HILLS, MINNES01 <br /> <br /> <br />For 0 ce Use Only <br />PERMIT APPLICATION NO. <br />Rec'd'Office Rec'd Engr. <br />Notice Sent . <br />Agenda <br />Administrative Fee <br /> <br /> <br />J Vl~\'2#~~-vY' <br /> <br />PERMIT APPLICATION <br /> <br />To be completed by the applicant <br /> <br /> <br />Owner: G(Da te : <br /> <br />Address: ~eqCf iltU-(} (04-- /~ N to 'Tel <br /> <br /> <br />Ci ty: ( 00 II".. \Q.rJ A ..~& fh A..r ~f' <br />, . (zip co e <br /> <br /> <br />Ib-~-&7 <br /> <br /> <br />Permit Application for Approval of: <br /> <br />[] Co~prehensive Stormwater <br />Management Plan <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 />Name of Project: ~,~ <br /> <br />Purpose of Project. ~.~ ~ 8-'~. <br /> <br />Location of Project-Address: . ~. q - 0- t d <br /> <br />Remarks: <br /> <br />r <br /> <br />,j . .1, <br /> <br />\+\IJ{ 8 <br /> <br />Iv ~14) B~ 1'...\ ".4,.... <br /> <br />Municipality or Township: <br />1/4 of Section <br /> <br />Township <br /> <br />Range <br /> <br />Call 483-0634 if assistance in completing this form is required. Please <br />attach drawings, plans and other data as outlined in "Rice Creek Watershed <br />District Permit Information Brochure~ available upon request. Mail or <br />deliver this form along with a $10.00 administrative fee .and appropriate <br />exhibits to the.tbove address. <br />.. <br /> <br />II A field inspection fee on this permit shall be charged to cover actual costs '. <br />related to a field inspection including the investigation of 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 any <br />required subsequent monitoring of the proposed activity." M.S.A. 112.88, <br />Subd. 2. Applying for this permit to RCWD does not ,preclude your applying <br />for any necessary permits that may be required from o~her governmental <br />agencies. . <br /> <br />A8-78 <br /> <br />t, <br /> <br />.Revised 2/2/81 <br />