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Minnesota • Conservation Act <br /> Application for Approval of Wetland Type and Boundary <br /> 1. Project/Site Information <br /> Project/Site Name: �56ao 7r Local Government Unit: 6 ;4 p K <br /> Location (address and/or T, R, Sec.): <br /> 2. Applicant Information <br /> Applicant Name: Aawl Dvbo,,,4 Address:15*6p <br /> City, State, Zip: 4p,_v,op <br /> E-mail: Phone: <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): -A"OAO�- &VWIW� f tact Person:�,�f�y,.,_ cods <br /> Address: JTg"Z H,"lp-UCity, State, Zip: <br /> E-mail: gPhone: J7'Y" D <br /> �l s,•1 a WJ <br /> 4. Description of Request <br /> Check all that apply: WWetland Boundary(must attach wetland delineation report) <br /> KWetland Type (Eggers & Reed and/or Circular 39 type) <br /> 5. Signature <br /> By signature below, the applicant requests a delermination 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 /> Applica or Auttloded 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 />