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For Office Use Only Permit App. #: Date Received: City of Mounds View 2401 Mounds View Blvd, Mounds View, MN 55112 Phone: 763-717-4000 Permit Application Form Project Name: Project Location: City or Township: Quarter: Project Purpose: Section: Amount/Payer: Check Number: County: Township: Range: Area of New and/or Reconstructed Impervious Area of Land Disturbance (acres): Surface (acres): ApplicantfLandowner (must be landowner or easement holder of record, and must sign application on Name: Address: Phone: Email: City: State: Zip: Official Representative (do not complete if same as above): Name: Address: Company: Phone: City: Email: State: Zip: Permitting Contact (developer, engineer, architect, wetland consultant, etc.): Name: Authorized Agent? Yes No Address: Company: Phone: City: Email: State Zip: Permitting Contact (developer, engineer, architect, wetland consultant, etc.): Name: Authorized Agent? Address: Company: Phone: City: Email: State Submittal Requirements Yes No Applications submitted to the City must be complete and contain all required materials for each applicable Rule. See the Rice Creek Watershed District website for additional guidance and complete rules. The City will communicate an incomplete application status to the applicant, and no further action will be taken until additional submittals are received. Applicant must submit one (1) full sized copy (a readable 11" x 17" is acceptable) and either one (1) reduced size copy or an electronic copy of all required information. Projects involving a Wetland Replacement Plan have special noticing requirements and require the submittal of four (4) copies of all wetland -related submittal materials. Permit applications involving wetland noticing must be submitted a minimum 50 calendar days prior to a regular City Council meeting; permit applications not involving wetland noticing must be submitted a minimum 40 calendar days prior to a regular City Council meeting. 1 City of Mounds View Stormwater Permit Application