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FOR LGU USE ONLY: <br /> -- Determination for Part 1: ❑ No WCA Jurisdiction <br /> ❑ Exempt:No._(per MN Rule 8420.0122) <br /> ❑ No Loss: _(A Bt...G,per MN Rule 8420.0220) <br /> ❑ Wetland Boundary or type <br /> ❑ Replacement required—applicant must complete Part 11 <br /> COMPLETE THE SECTION BELOW ONLY IF REPLACEMENT 18 NOT REOUIRED: <br /> Application is(check one): ❑Approved ❑Approved with conditions(conditions attached) ❑Denied <br /> Comments/Findings: <br /> LGU official signature Date <br /> Nmne and Title <br /> For Agricultural and Drainage exemptions(MN Rule 8420.0122 Subps.l and 2B),LGU has received proof of recording of restrictions <br /> (per MN Rule 8420.0115): <br /> ' County where recorded Date Document#assigned by recorder <br /> LGU official signature Date <br /> r <br /> i <br /> Minnesota Local/State/Federal Application Forms for Water/Wetland Projects <br /> ' Page 3 <br />