Laserfiche WebLink
• <br /> i <br /> � � . ' . • • . • � <br /> ' •• . • • � •• • . • . • •� . • :• •. <br /> 1. ProjecUSite Information <br /> ProjecUSite Name: 1910 Shoreline Drive Local Government Unit: Minnehaha Creek WD (Orono) <br /> Location (address and/or T, R, Sec.): SE '/. of Section 10, T117N, R23W <br /> 2. Applicant Information <br /> Applicant Name: Majid Fehresti Address: 8612 Terraceview Ln N <br /> �City, State, Zip: Maple Grove, MN 55311 <br /> E-mail: N/A Phone: 952-828-0006(Jack Smuckler, Architect) <br /> 3. Agent/Consultant Information <br /> Company Name(if applicable): Arrowhead Environmental Consul. Contact Person: Ben Carlson <br /> Address: 2909 Meadow Lane City, State, Zip: Mound, MN 55364 <br /> E-mail:benc@arrowheadec.com Phone: 612-237-5996 <br /> 4. Description of Request <br /> Check all that apply: C�1 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 the subject property or have permission from the <br /> landowner to pursue this determination. <br /> � COi"�'"+`� 5/21/12 <br /> Applicant or Authorized 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 <br /> Evaluation Panel Members. Check with your LGU regarding their submittal <br /> 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 />