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02/04/1999 09:09 651 - 766 -4196 RICE CREEK W DIST PAGE 01 <br /> MCI CREEK WATERSHED DISTRICT PERMIT APPLICATION NO ONLY) <br /> SUITE 330 ARDEN PLAZA -i <br /> 3386 LEXINGTON AVENUE N REC'D OFFICE. 0.)- (15' RECD ENOR ,{a'0!ii. <br /> ARDEN HILLS MN 551284058 NOTICE SENT ("A-C: AGENDA COD Oatiah $ <br /> PH (851) 788.4191/ FAX (551) 7854196 PERMIT FEE $_________ o • <br /> t:a7 pR,RMTT APPT,tCATION <br /> 4.40 <br /> TO BE COMPLETED BY PL/CANT (Private Land Owner or Contractor for Public Projects)' <br /> (Please Print) / <br /> Owner l r j2/ ////I, Today's Date 9 9 - <br /> Address 7!9 S /�nun "-fly/ 7 , Day Phone (a/ L. 5122z 8: <br /> City /Zip ;.e 7 /, ' - de, / FAX ( &4') 4°'-+ ^ „.5. 6 <br /> Owner's Signature: e ��� Anticipated Project Start <br /> (No naen] wlo Mint si..'s r- •• - not appear... /// er / /% <br /> tatty of audantyl <br /> Permit Agolicadon for Annrnyal of. Design Eagfnet Con act: l �{ <br /> = Land Development Plan Name // a /�'/ /•9e•P/'/ <br /> Final Site Drainage Plan Address <br /> 0 Streets and Utilities Plan Phone f /) 7/ iC- 4/L <br /> s/ <br /> C Bridge and/or Culvert Plan FAX (G ) '7C, /.' /9 <br /> = Wetland Alteration Plan <br /> Q Shoreland Alteration Plan Erosion Control/Grading Contact for our Inspector: <br /> o Public/Private Drainage System Plat Name <br /> = Other (explain in remarks) Phone ( ) <br /> Cell Phone ( ) ' <br /> FAX (_) <br /> REMARKS: <br /> Project Name: �/ 11.2r . riel ee 5; L/ 49ie e. <br /> Project Purpose: ,Da1/ ( /t.. GdQ�,Jy" ttr. /A-4 <br /> Project Location: /4" / /' 1) / 15; )47471'04 747n'4 7 / / <br /> City or Town: ( /07r 7// fix ""7j7 53 <br /> I14 of Seeeee Township N Range W <br /> If approved. the permit will be valid for 18 months and may be extended at no charge if requested. Call (651) 766 -4192 for assistance in • <br /> completing this form. Please attach 3 copies of drawings, plans and other data as outlined in "Rice Creek Watershed District Permit <br /> Information Brochure (P1B)," available upon request Mail or deliver this form along with the appropriate fee according to schedule on <br /> Page 4 of the PLB, and THREE sets of appropriate exhibits including a stmt location trap to the above address, Applying for this peemr, <br /> from RCWD does not preclude your applying for any necessary permits that may be required from OTHER governmental agencies. <br />