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PLEASE COMPLETE THt FORM --DO NOT WRITE: <br />RICE CREEK WATERSHED DISTRICT <br />SUITE 374, ARDEN PLAZA <br />3585 NORTH LEXINGTON AVENUE <br />ARDEN HILLS, MINNESOTA 55126 <br />cc: City of Roseville <br />J.M. Montgomery, Inc. <br />RCWD File <br />act- J38 <br />"See Attached". ONLY BLUE FORMS ACCEPTED. <br />For Office Use Only <br />PERMIT APPLICATION NO. 91-19 <br />Rec' d Office 3-6-91 Rec' d Engr. 3-11-91 <br />Notice Sent 3-7-91 <br />Agenda 3-27-91 <br />Administrative Fee 60 ck. 7F7632250 <br />Como N-Town Credit Union <br />PERMIT APPLICATION <br />Tobecompleted by the applicant <br />Owner: ✓zAryK ZexySr! <br />Address: /ZZS^ .J OSEPfI/NE l20 <br />City: sE- y L CF WILn - 5-S//3 <br />zip code <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 />Date: Z- L. O - 9/ 1 <br />Telephone No.:At- •7eZ- ae8 t Gh- y89�/3aB <br />sl qfnatu of awn No _gents Sig. accepted. <br />Remarks: <br />This is a request fo renewal Permit # S9 1:5� <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 />w , 774 A J Cn 2cc vis iOAvS . <br />OQ_�Q. Nam. <br />Purpose of Project: Retainiag wall/deck adjacent to Lake Josep ine - <br />Location of Project -Address: 1225 Josephine Road <br />Municipality or Township: Roseville <br />NE 1/4 of Section 3 Township L9N _ Range <br />Call 483-0634 it 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. Mail or <br />deliver this form along with a $60 fee ($10 administrative fee and S50 for <br />two inspections) and two sets of appropriate exhibits to the above address, <br />Engineering review fees will be billed after final Board action. <br />"A field inspection fee on this permit shall be charged to cover actual coats <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.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 />A8-78 Revised--2- <br />