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y. ProjecUSite In#ormatian <br /> Project/Site Name: 290Q Deer F2un Trail Local Governrr�ent Unit: MCWD <br /> Location (address andlo�T, R, Sec.): T117N, R23W, Sec 4 <br /> 2. Appiicant lnformat�an <br /> Appiicant Name: Marcia Hammond Address:2900 Deer Run Trail <br /> City, State,Zip: Orona, MN, 55356 � <br /> E-mail: Phone: 763-559-8907 <br /> 3. AgenUConsult�nt information <br /> Company Name (if applicabfe): SER Contact Person: Brian Burgner <br /> Address: 25580 Nelsine Drive City, State,Tip: Shorewood, MN 55331 <br /> E-mail: brianb@gpsinnovations.com Phone: 612-790-5511 <br /> 4. Description of Request <br /> Check all that appfy: �Wetland Bc�undary(must attach wetiand delineation report} <br /> �Wetland Type (Eggers & Reed and/or Circular 39 typej <br /> 5. Signature <br /> By signature beiow,the appiicant requests a determinatian#rom the Locai Govemment Unit under <br /> Minnesota Rules 8420.0225 nn the submitted wetland boundary and type informatian in this appiication. <br /> The appficant also affirms ihat they are the owner of the subject property ar have permission from the <br /> lan wner to urs eterminatian <br /> � tf-�Q -�f <br /> rca ar A gent Signature Date <br /> Important Notes: <br /> � The appiicant may be required to submit mu�iple copiss o#the repartlinformation ta tF�e <br /> LGU.The LGU may require the appiicanE to submit capies directly to Technical Evafuatian <br /> Panel Members. Check wlth your LGU regardtng thefr submhttel requirements. <br /> • The LGU deeision must be made in compliance wiih Minnesota Statutes,section 15.99. <br /> For LGU use anly <br /> Date Received: <br /> Pags 1 of 1 <br /> BWSR Wetland Baundary/Type Application Form 11110/08 <br />