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Ed Marchan ● Don Pereira ● John Brach ● Rick Gelbmann ● William Armstrong <br />P.O. Box 838 | Lake Elmo, MN 55042-0538 | www.vbwd.org <br />Return completed and signed application to <br />John Hanson, VBWD Engineer <br />jhanson@barr.com <br />A permit fee shall accompany this permit, unless waived by the Board of Managers. <br />Governmental bodies are not required to pay a fee. <br />Project Information <br />Project Name <br />Location (address, if known; otherwise major intersection) <br />City or Township <br />Parcel Identification Number (if known) <br />Section, Township, Range (if known) Section: Township: Range: <br />Project Timeline Estimate Start: Complete: <br />Project Contacts <br />Applicant Authorized Agent Owner (if different than applicant) <br />Name <br />Company (if applicable) <br />Address <br />City, State, Zip <br />Phone <br />Email <br />Once a Valley Branch Watershed District permit has been approved, the permit conditions will be attached to the back of this form. <br />By signing this permit application, the permit applicant, his/her agent, and owner (hereinafter “Permittee”) shall abide by all the <br />conditions set by the Valley Branch Watershed District (VBWD). All work which violates the terms of the permit by reason of <br />presenting a serious threat of soil erosion, sedimentation, or an adverse effect upon water quality or quantity, or violating any rule <br />of the VBWD may result in the VBWD issuing a Stop Work Order, which shall immediately cause the work on the project related to <br />the permit to cease and desist. All work on the project shall cease until the permit conditions are met and approved by the VBWD <br />representatives. In the event Permittee contests the Stop Work Order issued by the VBWD, Permittee shall attend a VBWD Board of <br />Managers meeting and discuss the project. Any attorney fees, costs, or other expenses incurred on behalf of the VBWD in enforcing <br />the terms of the permit shall be the sole expense of the permit applicant. Costs shall be payable from the permit applicant’s permit <br />fee. If said fees exceed the permit amount, the Permittee shall have ten (10) days from the date of receipt of the invoice from the <br />VBWD to pay for the cost incurred in enforcing the permit, by which to pay the VBWD for said costs. If costs are not paid within the <br />ten (10) days, the VBWD will draw on the permit applicant’s surety. The Permittee agrees to be bound by the terms of the final <br />permit and conditions required by the VBWD for approval of the permit. The permit applicant further acknowledges that he/she <br />has the authority to bind the owner of the property and/or any entity performing the work on the property pursuant to the terms <br />of the VBWD permit, and shall be responsible for complying with the terms of the VBWD permit. <br />Signatures (Required): <br />Applicant Authorized Agent Owner (if different than applicant) <br />Signature <br />Date <br />VALLEY BRANCH WATERSHED DISTRICT TO BE COMPLETED BY VBWD: <br />PERMIT APPLICATION Permit Number: <br />Permit Fee Rec’d: <br />Date Rec’d: <br />10/24/2024 <br />2024-43 <br />Waived <br />N/A