Laserfiche WebLink
. 06/15/2000 16:24 <br />651 -766 -4196 <br />• <br />RICE CREEK WAYERSREa DISTRICT <br />SUITE 330�G ARDEN <br />3585 LEXINGTON AVENUE N <br />ARDEN HILLS MN 55126-80576196 <br />PH (651) 766 -41911 FX (651) <br />c: City of LI no \ -' <br />Montgomery Watson <br />Inspector Brough <br />ttCWD <br />TO BE COMPLETED BY APPLICANT <br />(Please Print) s <br />Owner a • ' • <br />Address <br />City/Zip <br />RICE CREEK W DIST <br />(FOP. OFFICE USE ONLY) <br />PERMIT APPLICATION NO. EC DD ENGR <br />RECD OFFICE AGENDA a <br />NOTICE SENT 16 00 oo fa~ tkr <br />PERMIT FEE S L" . <br />PAGE 01 <br />(private Land Owner or Contractor for Public Projects) -2C� <br />Today's Date <br />Day Phone (�� <br />FAX LL, -570 <br />Anticipated Project Start Date: <br />2GOo <br />Owner's Signature: <br />(No agcntS w/o s <br />lever of authontY) <br />• <br />• <br />(P if it does not appear above.) <br />n signer's name <br />au ( W . IV©la"? <br />• V <br />C-3 Land Development Plan <br />CST Final Site Drainage Plan <br />Q Streets and Utilities Plan <br />Q Bridge and/or Culvert Plan <br />Wetland Alteration Plan <br />Shoreland Alteration Plan <br />0 Public/Private Drainage System Plan <br />En Other (explain in remarks) <br />REMARKS: <br />Project Name: <br />Project Purpose: <br />Project Location: <br />City or Town: <br />Design Engineer Contact: <br />Name <br />Address <br />Phone (Z(,23) <br />q s <br />FAX (2fp z <br />Erosion ControllGradin : Contact for our Ins r: Q /G <br />Name ;t:.a ,' i Y l� <br />Phone (1,251_)___ 3� �5 <br />Cell Phone (�2,..) S Q <br />FAX (% <br />/nt <br />County <br />w <br />---1 /4 of Section Township <br />e if requested. Call (651) 766 -4192 for assistance. ' <br />t will be valid for 18 months and may be extended at no charge 9 <br />cf completing ing the permit copies of drawings, plans and other data as outlined in "Rice Creek Watershed District Permit <br />01 <br />completing this form. Please attach 3 cop with the appropriate fee according <br />" available upon request Mail or deliver this form along to the above address. Applying tt schedule <br />pert <br />Information Brochure (PIB)," to exhibits including a street location map <br />Page 4 of the P18, and TIME sets of appropriate permits that may be required from OTHER govcrnmeAtal agencies. <br />from RCWD dos not preclude your applying for any necessary p <br />For+ A8 -18, Revised 03 -04-99 <br />N Range <br />