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Revised 7/22/92 Permit No. <br />Date Received <br />LOWER RUM RIVER WATERSHED MANAGEMENT ORGANIZATION <br />ANDOVER - ANOKA - COON RAPIDS - RAMSEY <br />Permit Application for Construction <br />A $500 escrow deposit shall accompany this permit. Applicant <br />acknowledges familiarity with LRRWMO rules, regulations, and <br />ordinances. Permits are to be processed with the site plan, <br />plat application, and approval of the city in which the <br />project is located. <br />OWNER C::i.� <br />ADDRESS ISt5'S tiL) 141w <br />APPLICANT <br />ADDRE jS/ <br />/r <br />mature of Applicant <br />NOTE: The applicant assumes <br />compliance with permit conditions. <br />PROJECT NAME <br />SCC�k <br />PHONE 431-140 <br />PHONE `1 2i - l y ( 6 <br />DATE / 13 / 15- <br />all responsibility for <br />ADDRESS/LOCATION N i S 2Z T 3}}2 U R 2 S Lv {{ <br />PROJECT DESCRIPTION/PURPOSE j¢¢ .:i t-Vc cti, 1 <br />PROJECT SUBMITTALS <br />GRADING PLAN: Including existing and proposed <br />contours and boundaries of all wetlands and surface <br />waters. <br />STORM SEWER/DRAINAGE PLAN: Including all permanent <br />drainage features and all permanent water quality <br />features. <br />EROSION CONTROL PLAN: Including all temporary <br />measures proposed to maintain all sediment on site. <br />MITIGATION PLAN: Quality level of mitigated <br />wetland(s) shall be determined by the LRRWMO. <br />START OF PROJECT ESTIMATED END OF PROJECT <br />PROJECT APPROVAL DATE: <br />SIGNATURE OF LRRWMO CHAIRMAN <br />