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RICE. CREEK WATERSHED DISTRICT Por O- >.ce Use Onl.yT <br />SUITE, 177, ARDEN PLAZA <br />PERMIT APPLICATION NO. <br />3585 NORTH LEXINGTON AVENUE Rec',i Office Rec d Engr. <br />ARDEN HILLS, MINNESOTA 55126 Notice Sent <br />Agenda <br />Administrative Fee <br />PERMIT APPLICATION <br />To be completed by the ap lip cant <br />Owner: C 11 7 iV ,•u.'vn•i;.; v:IN, Date: <br />Address: 1 11.•; Ihi P _ Telephone. No.: <br />City: MPr J3 �,r',. nle= ; 5111 zip code) ri.gn' ature of Owned ::'.:...v ..a :rl07f11r.'41 <br />Permit Application for Approval of: <br />[� Comprehensive 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 />Remarks: <br />n'F1'1111C JI".11r,01- )):Jilt I.a 0AI(M S <br />Wetland Alteration <br />(Riparian) Improvement <br />Private D <br />Private Drainage System <br />Individual Sewage Treatment System <br />_ other (explain in remarks) <br />Name of Project: A.� %_(1 L!s— Ji 11 / i.LiLl 1217 f 11 'a l ',, 41 n nir 19 1j S <br />Purpose of Project: It'//'1�11i_�:1l rl 1V 11 5 ('RI! la. fjL rq J73 ti nlr �.• i ('r lCFl dr_ <br />Location of Project -Address: Nr,3R N:LLVI .v .ro+ 1(IV J1LL 14.' :11P+•,•1S.1)EW <br />Municipality or Township:_ L it ', 1'i 111 cf...,,: <br />lk of Section 5 Township j /) Range <br />Call 483-0634 if assistance in completing this form is required. Please <br />attach drawings, plans and other data as outlinad 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 above address. <br />"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 activitv." 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 other governmental <br />agencies. <br />AB-78 Revised 2/2/81 <br />Attachment #8 <br />