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' � i E � � ♦� <br /> ' • • � � ' t • e e e e ^ � e : � e . <br /> �---- ------ -- --- --______-- _-------_______-----------�_- ---_...__-- <br /> � 1. Project/Site Information <br /> ' , <br /> � ProjecUSite Name: Stonegate Delineation Loca{ Government Unit: � <br /> i <br /> Location (address and/or T, R, Sec.): PID 28-118-23-24-0001 <br /> ���l� '�'-���f 2. Applicant Information <br /> �,�.-� /�_s�-zvv^�� ����7n/,rn�-�c-1' C.!��" . ' j GL� �r7 `'���Gt<��r <br /> Applicant Name: (See attached for info) Address. �'�s � y <br /> City, State, Zip: �p� P�,r+ f , MN 5�53 y y <br /> E-maii: SvSC�.r'> . SGC.((,� ✓�� L.°• P(G. �� -Z Phone: �D%:� -���)J -/c���.3 <br /> 3. AgentlConsuitant Information <br /> Company Name (if applicable): Contact Person: <br /> Address: City, State,Zip: <br /> E-rnail: Phone: <br /> 4. Description of Request <br /> Check alf that apply: �'�/Vetland Boundary(must attach wetland delineation report) <br /> O Wetiand Type (Eggers& Reed and/or Circular 39 rype) <br /> 5. Signature <br /> By signature below, the applicant requests a determination from the Local Govemment 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 /> la owner to pursue this determination. <br /> ���� � ���-�- y-�-��,s-, <br /> A plicant or Auth�orized Agent Signat re 1 Date � <br /> ,, , � ,` . , - <br /> I portant 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 su6mittal requirements. <br /> . The LGU decision must be made in compliance with Minnesota Statutes, section 15.99. <br /> For LGU use only <br /> Project#: W�-1 S� � Fee Received: � � ' Date Received: � ��l� <br /> Page 1 of 1 <br /> BWSR Weiland Boundary/Type Application Form 11/10/08 <br />