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PLEASE COMPLETE THE FORIM--DO NOT WRITE "See �Attach d" ONLY BL <br />UE lLL1E FORIyS A". <br />RICE CREEK WATERSHED DISTRICT <br />SUITE 374, ARDEN PLAZA <br />3585 NORTH LEXINGTON AVENUE <br />ARDEN HILLS, MINNESOTA 55126 <br />PERMIT APPLICATION <br />To be completed by the applicant <br />Owner: AXANte- )E>E1c VS K ! Date: <br />Address: Telephone No.: <br />City: vgGc,e <br />zip code SVgnatu e o Owner AgentsSi g. accepted.' <br />Permit Application for Approval of: Remarks: <br />EJ Comprehensive Stormwater w,g, <br />Pk7 <br />Management Plan <br />Land Development Plan �g - /6,7 <br />it.4'D C�ANG�. <br />Final Site Drainage Plan <br />Use and/or Appropriation 7O P2iEU/py's <br />06AwS, <br />of Public Waters <br />Bridge and/or Culvert Construction <br />Wetland Alteration <br />Shoreland (Riparian) Improvement <br />Private Drainage System <br />Individual Sewage Treatment System <br />Other (explain in remarks) <br />Name of Project: <br />Purpose of Proje <br />Location of Proj <br />Municipality or Township:fjj�y-P_..- <br />n%G -1/4 of Se ztion `.3 Township C;Z`57 Range �vV <br />Call 483-0634 if assistance in completing this form is required. Please <br />attach drawings, plans and other data as outlined in "Rice Creek Watershed <br />District Permit Information Brochure; available upon request. �Ma <br />}:along :with a $10.06 administrative fee and approp'ri ' ' '' (2 sets) <br />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 activity." M.S.R. 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 />