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- • . - • • - . • • <br /> ' • � • • ' • • � _ • • •- . � : • • . <br /> 1. Project/Site Information <br /> Project/Site Name: �,�� ��, �����L�ocal Government Unit: �=-�r o� q.�o <br /> Location (address and/or T, R, Sec.): �,'.,�,s �yy� ���� �� ���� ��� <br /> 2. Applicant Information <br /> Applicant Name: ��;�(, ��� Address: 2,�.�.3 �(,y��r����� <br /> City, State, zip: �/'�►,�,,�J �N �331 <br /> E-mail: Phone: q$`2—�?� —O 1 11 <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable):��� ���,�;�tontact Person: �qy� �q��� <br /> / <br /> Address: �Z� �{„�,,,�y�,� ��� City, State, Zip:��}c� ��,�,, �.� <br /> E-mail: �a� Phone: �3� <br /> J �^�✓� l�raa.c.� �J2- 0 2— G <br /> 4. Description r�f Request <br /> Check all that apply: I,�Wetland Boundary (must attach wetland delineation report) <br /> ;$Wetland Type (Eggers & Reed and/or Circular 39 type) <br /> 5. Signature <br /> By signature below, the applicant requests a determination from the Local Government Unit under <br /> Minnesota Rules 8420.0225 on the submitted wetland boundary and type information in this application. <br /> The applicant also affirms that they are the owner of th� subject property or have permission from the <br /> landowner to pursue this determination. <br /> 9/zs/�r 3 <br /> Applican r Autho d Agent Signature Date <br /> Important Notes: <br /> • The applicant may be required to submit multiple copies of the report/information to the <br /> LGU. The LGU may require the applicant to submit copies directly to Technical Evaluation <br /> Panel Members. Check with your LGU regarding their submittal requirements. <br /> • The LGU decision must be made in compliance with Minnesota Statutes, section 15.99. <br /> For LGU use only <br /> Date Received: <br /> Page 1 of 1 <br /> BWSR Wetland Boundary/Type Application Form 11/10/08 <br />