HomeMy WebLinkAbout2005-08-11 Brown's Creek WD Permit Applicationr
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BROWN'S C K
WATERSHED DISTRICT
1380 w Frontage Rd, Hwy 36, Stillwater, MN 55082 Tel: 651 - 275- -1136 ext 26 Fax: 651- 275 - -125 4
PERMIT APPLICATION
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Project Information To Be Completed By The Applicant
Date ` //U /�
Name of Pro,leet.
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Purpose of Projec
Location of Project (street address, if known):
City r Township: 0&,W_
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Legal description: Section: 1/4 Section: Township. g
General Project Description; J3CA1L
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Name of Authorized Agent:
Representing. Fo L"-?, C.
Street Address.
City: ST f Lk, zi :55
Day Telephone.
Signature of Authorized Agent)
Name of Property Owner:
Sr e�,C� t-v-M7�
Owner's Street Address: � 377 4- C'WA1vZ �UD /
Owner's City: !;5:t/ L(. (.�• H'!�Z Owner's Zip: 5�50& Z—
Owner's Telephone: 5e.M0wner's Fax- E6-�� T ✓� ('"�
OWNERS SIGNATURE (REQUIRED): /
Managers:
Craig Leiser, President ' Gail Pundsack, Vice- President ' Connie Taillon, Treasurer ' Gerald Johnson, Secretary
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B ROWN'S
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WATERSHED DISTRICT
1380 W Frontage Rd, HNNTy 36, Stillwater, NISI 55082 Tel: 651- 275 -1 136 ext 26 Fax: 651-275-1254
PERMIT APPLICATION
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Permit Application for Approval of:
(check all that a
(!} Land Development Subdivisions of 4 or more lots (Rules 2.0 - 7.0) $1000
Greater than 4 lots $50/additional lot
Grading or Alteration (lZules 2.0 -7.0}
Activities /Grading less than l acre $1000
� l .0 4.99 acres $1250 -4 1
5.0 - 19.9 acres $1500
20 or more acre $2400
} Shoreland or Streambank Alterations (Rule 5.0) $500 -
Impacts or Alterations to a waterbody or ditch (Rules 6.0 &. 7.0)
�} Projects within floodplain of waterbody or ditch $500
[} Crossing of a waterbody or ditch $1500
TOTAL FEE DEPOSIT x (25 0, v
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APPLICATION FEE ESCROW WILL BE CUMULATIVE FOR EACH APPLICABLE CA TEGGR Y . When a project is approved by the
BCWD Board, the permit fee deposit must be replenished to the deposit amount by the applicant before the permit will be issued to cover
actual costs incurred to monitor compliance and address non - compliance with the BCWD Rules. ANY COSTS INCU B Y THE BCFYD
GREATER THAN THE PERMIT FEE DEPOSIT BALANCE WILL BE BILLED TO THE APPLICANT. Any unused portion of the
deposit balance will be returned to the applicant when the Board determines that the work has been completed under the permit
Performance Suret
y Deposit
Additional Project Information (required)
The BCWD Board will determine a performance surety amount in addition to the Permit Fee Deposit. The amount of the surety
will be based on the following criteria. The BCWD Board may consider payments made in lieu of site specific mitigation.
Total Area of Disturbed Land Surface as � Result of This Projel t (acres) � � �<
Estimated Construction Cost of Stormwater Managment Facilities (incudes ponds, pipes, etc.)
Call (651) 275 -1135 ext 26 if Assistance In completing this form Is required. Please Attach drawings, plans and other data as outlined In "Brown's Creek Watershed District,
Permit Information Brochure," available upon request. Mail or deliver this form along with the appropriate Permit Fee Deposit and the Appropriate type and number of eahlbits
to the above address. Applying for this permit from BCWD does not preclude your applying for any necessary permits that may be required from other governmental agencies.
Managers: '
Craig Leiser, President Gail Pundsack, Vice- President ' Connie Taillon, Treasurer ' Gerald Johnson, Secretary
$ 6 9 03.
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W el l s F argo Bank 3
Stillwater a€� ioe
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CHECK# 57883
2000 Northwestern Avenue
BUICK - CHEVROLET • JEEP
H ' ] LNCE 1932 •
• FAAtlLY ❑ 'hl:i S
Stillwater, MN 55082
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5 7 88 3 '
5900 Stillwater Boulc•tird North . P.0. Box 337
Scillwatcr. MN 5SO82
(65 1) 4394333
ONE THOUSAND TWO HUNDRED
PAY.
FIFTY
DOLLARS AN11 O l
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DATE
AMOUNT
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a81� 0 05
$ 'i,250.00
TO THE
BROWN'S CREEK WATERSHED DISTVICT, = F ='
STILLWATER MOTOR COMPANY
{ ORDER
1825 CURVE CREST BOULEVARD, t ='
'OF
STILLWATER MN 55882
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AUTHOR
SIGNATURE
NAME NUMBER DATE
BROWN'S CREEK WATERSHED DISTRICT 08/10/05
FOR PERMIT APPLICATION
ACCT# AMOUNT CTRL# DESC
72A 413.00
72B 250.00
72D 262.00
72 150,00
72i 1 75.00
REMITTANCE ADVICE CHECK NO.
DETACH AND RETAIN STILLWATER MOTOR CO. 57883 AMOUNT $1,250-00
STILLWATER, MN 55082
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