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I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />I <br />I <br />! <br />I <br />I <br />I <br />I <br />I <br />! <br />I <br /> <br /> Permit No. <br /> <br />bate Received <br />LO~ RUM RIVF~ WATERSHED MANAGEMENT ORGANIZATION <br /> <br /> ANDOVER o ANOKA- COON RAPIDS - RAMSE¥ <br /> <br /> Permit Application for Construction <br /> <br />A $500 em~ow ,deposit shall accompany this permit. Governmental Bodies are <br />not required ~o pay a fee. Applicant acknowled§es familiarity with LRR~MO <br /> Re.gu~at~ons_ -- and Ordinances. Permits are to be processed wi~h the Site <br />rules <br />Plan / <br />located. <br /> <br />OWNER <br /> <br />ADDRES <br /> <br />APPLICANT_ <br /> <br />ADDRESS_ . =_; <br /> <br />Signature~ ~f [ <br /> ~ . a~plicant <br />Note: The~ ~pI,~Cant assumes all responsibility for compliance with permit <br /> condf~ion~. <br /> ! <br /> <br />PROJE~T NAKE <br /> <br />ADDRES s/LO ,~ATION <br /> <br />PROJECT SU~iTTALS <br /> GRADI~i~LAN: including existing and proposed contours and boundaries <br /> of all wetlands and surface water~. <br /> [ <br /> STOR~ SE~ER/DRAINAGE PI-~N: including all permanent drainage features <br /> and all permanent water quality features. <br /> EROSION CONTROL PLAN: including all temporary measures proposed to <br /> maintain all sediment on site. <br /> <br />START OF PROJECT <br /> <br />ESTIMATED END OF PROJECT <br /> <br /> <br />