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<br /> <br />Project Name: <br />Project Location: <br />Type of Work: Residential Commercial, Industrial <br /> <br />Name: Phone ( ) <br /> Last First MI <br />Address: <br />Property <br />Owner <br />City: State: Zip Code: <br />Company: Phone ( ) <br />Name: <br /> Last First MI <br />Address: <br />Contractor <br />City: State: Zip Code: <br />Company: Phone ( ) <br />Name: <br /> Last First MI <br />Address: <br />Engineer / <br />Designer <br />City: State: Zip Code: <br /> <br />Project Size: Less than 1 (one) acre More than 1 (one) acre* <br /> * - Project over 1 (one) acre must obtain a National Pollution Discharge Elimination System (NPDES) permit for the MPCA. Copy of <br />the erosion and sediment plan according to the City of Mounds View Land Disturbance and Implementation Plan must be submitted to <br />the City <br /> <br /> <br /> <br />Description of <br />work: <br /> <br />Number of Cubic Yards: <br />Are there critical areas on the project such as wetlands, steep slopes, or other natural features? Yes No <br />Date of when work is to begin? <br />Date of when turf restoration is to be complete? <br />Who will be the primary person to contact for erosion and sediment control issues? <br />Name: Phone: ( ) <br /> <br /> <br />NOTE: Absolutely NO land disturbing activity may begin until the Land Disturbance Plan has been <br />approved and permit has been issued. <br /> <br /> <br />Office Use Only <br />Permit No. <br /> <br /> <br />City of Mounds View <br />2401 Highway 10 <br />Mounds View, MN 55112 <br />Phone: (763) 717-4000 <br />Fax: (763) 784-3462