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27. SIGNED AFFIRMATIONS: Sign and date either Box 27a or Box 27b below. If your project involves replacement <br /> by wetland banking only, sign Box 27a. For all other projects, read Box 27b, check appropriate boxes in Part B,and sign. <br /> 27a. For projects involving replacement by wetland banking only: <br /> To the best of my knowledge and belief,all information in Part 2 is true, complete and accurate; and I affirm <br /> that the wetland losses will be replaced via withdrawal from an account in the State Wetland Bank. <br /> Signature of applicant or agent Date <br /> 27b. For projects involving either project-specific replacement only or a combination of wetland banking <br /> and project-specific replacement: <br /> Part A:The replacement wetland (affirm all statements): <br /> •Was not previously restored or created under a prior approved replacement plan;AND <br /> ■Was not drained or filled under an exemption during the previous 10 years;AND <br /> ■Was not restored with financial assistance from public conservation programs;AND <br /> ■Was not restored using private funds,other than those of the landowner,unless the funds are paid back <br /> with interest to the individual or organization that funded the restoration; and the individual or organization <br /> notifies the local government unit in writing that the restored wetland may be considered for replacement. <br /> Part B:Additional assurances(check all that apply): <br /> ❑The wetland will be replaced before or concurrent with the actual draining or filling of a wetland. <br /> ❑An irrevocable bank letter of credit,performance bond, or other acceptable security has been provided <br /> to guarantee the successful completion of the wetland replacement. <br /> ❑The wetland losses will be replaced via withdrawal from an account in the State Wetland Bank. <br /> Part C: For projects involving any project-specific replacement: Within 30 days of either receiving approval <br /> of this application or beginning work on the project,I will record the Declaration of Restrictions and Covenants <br /> on the deed for the property on which the replacement wetland(s) will be located; and I will at the same time <br /> submit proof of such recording to the LGU. <br /> To the best of my knowledge and belief,all information in Part 2 is true,complete and accurate; and I affirm <br /> all statements in Parts A and C,as well as checked assurance(s)in Part B. <br /> Signature of applicant or agent Date <br /> FOR LGU USE ONLY <br /> Replacement plan is(check one): O Approved D Approved with conditions(conditions attached) O Denied <br /> LGU official signature Date <br /> LGU has received evidence of title and proof of recording of Declaration of Restrictions and Covenants for Replacement Wetland: <br /> County where recorded Date recorded Document#assigned by recorder <br /> LGU official signature Date <br /> 8 <br />