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1. Project/Site Information <br />Project/Site Name: Lakeview Golf Course local Government Unit: Minnehaha Creek WD <br />Location (address and/or T, R, Sec.): T117, R23W, Sec 6 <br />2. Applicant Information <br />Applicant Name: Source Land Capital, Chase Peterson Address: 18215 45th Ave N, Suite D <br />City, State, Zip: Plymouth MN 55446 <br />E-mail: chasep@sourceland.com Phone: Phone: (763)-551-0100 <br />3. Agent/Consultant Information <br />Company Name (if applicable): Kjolhaug Environmental Contact Person: Melissa Barrett <br />Address: 26105 Wild Rose Lane City, State, Zip: Shorewood, MN 55331 <br />E-mail: melissa@kjolhaugenv.com Phone: 952-401-8757 <br />4. Description of Request <br />Check all that apply: X Wetland Boundary (must attach wetland delineation report) <br />X 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 pursue this determination. <br />C <br />Applicant oi� Authorize -Agent Signa ure Date <br />Important Notes: <br />The applicant may be required to submit multiple copies of the reportlinformation 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 />