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., . � <br /> • . . • • • ' <br /> � 9 • • 0 � � • • i 0 a 9 9 ' 0 � 0 0 . <br /> ..»��: ..�-; _ _ . x�w <br /> 1. Praject/Site information <br /> Project/Site Name: 2100 6th Ave N Local Government Unit: Orono <br /> Loeation (address and/or T, R, SBC.�: �'hillips�Noodland Terrace 2nd Addition,Lol'L,Block 1. Part of Section 27,T118N.K23W <br /> 2. Appticant Information <br /> Applicant Name: Orono Woodlands, Inc -Gladys McClendon Address: 2100 6th AvP, N, F'O Box 507 <br /> City, State, Zip: Long Lake, MN 55356 <br /> E-mail: oronomcciendon c7 aol.com Phone: 952-471-1100 <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): Svoboda Ecologica��esources Contact Person: Frank Svoboda <br /> Address: 25580 Nelsine Drive City, State, Zip: Shor�wood,MN,55331 <br /> E-mail: franks�c�g�sinnovations.com Phone: 952-411-1100 <br /> 4. Description of Request <br /> Check all that apply: C7 Wetland Boundary(must attach wetland delineation report) <br /> O 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 he owner of the subject property or have permission from the <br /> lando er to pur ue this deter iatio . <br /> ' � � l <br /> App ican or Authorized Ag Si ture 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 requirernents. <br /> • The LGU decision must be made in compliance with Minnesota Statutes, section 15.99. <br /> For LGU use only � ^ <br /> Date Fieceived: <br /> Page 1 of 1 <br /> E3WSR Wetland E3oundary/Type Applicalion Form 11;10/08 <br />