Laserfiche WebLink
+r� i <br /> �J (( I lV <br /> ' • . • • • � I <br /> i <br /> � •• � • � •Y • . � � �' r • �• � . � <br /> I <br /> 1, Project/Site Information <br /> Project/Site Name: 445 Brown Road Local Government Unit: MCWD <br /> Location (address and/or T, R, Sec.): Section 3, T117N, R23W <br /> 2. Applicant Information <br /> Appiicant Name: Travis Senenfelder Address:440 2nd Street <br /> City, State, Zip: Exceisior, MN, 55331 . <br /> E-mail: Phone: 952-460-3421 <br /> 3.Agent/Consultant Information <br /> Company Name (if applicable): SER Contact Person: Brian Burgner <br /> Address: 25580 Nelsine Drive City, State, Zip: Shorewood, MN 55331 <br /> E-mail: brianb@gpsinnovations.com Phone: 612-790-5511 <br /> 4. Description of Request <br /> Check all that apply: �Wetland B�undary(must attach wetland delineation report) <br /> �Wetland Type (Eggers & Reed andlor 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 wetfand 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 /> lan er to pursue t ' ter ination. <br /> ' /� �o� Zo�/ <br /> ppli nt or uth ize t Signature Date <br /> Important Notes: <br /> • The applicant may be required to submit multiple copies of the reporUinformation 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 thefr submfttal requiremenis. <br /> • The LGU decision must be made in compliance with Minnesota Statutes, section 15.99. I <br /> For LGU use only SFP � � 2011' SEP 16 2011 ; <br /> Date Received: <br /> Page 1 of 1 <br /> BWSR Wetland Boundary/Type Application Form 11/10/08 i <br /> I <br />