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�o� City of Orono <br /> � � 2750 Kelley Parkway <br /> P.O. Box 66 <br /> � �� .,I,' � Crystal8ay, MN 55323 <br /> . G (952) 249 4600 <br /> ��o�'�' Fax: (952) 249-4616 <br /> REQUEST FOR WETLAND BUFFER EVALUATION <br /> Property Address: <br /> Person Making Request: <br /> This person is the: <br /> ❑ Property Owner ❑ Owner's Contractor/Consultant ❑Other <br /> Company Name <br /> Address <br /> City Zip <br /> Daytime Phone <br /> Email <br /> What work is planned? <br /> Signature of person making request <br /> Date: <br /> Staff use only <br /> Date received <br /> ❑ Two copies of delineation <br /> ❑ Two copies of survey <br /> ❑ Two copies of MCWD acceptance <br /> Date sent to Bonestroo <br /> Date report received <br /> Date report forwarded to applicant <br />