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- <br /> ' i " • � ' � � <br /> 1 • � � • � • • • � - • • C • i • � . <br /> • 9. ProjecUSite Information <br /> Project/Site Name: ��oo �r,.�,,,� � ,5'0� Local Government Unit: j�t:.,H��-ti,�,�, ��-�.�K ���D <br /> Location (address andlor T, R, Sec.); 'j' /�•7N� �23W �V��,� o�' 5�,��„� �0 <br /> 2. Applicant Information <br /> I <br /> Applicant Name: �;�(�� /�b�� Address: rOpD �,,.ti„ ��.�,( ��,{y� � <br /> i <br /> City, State, Zip: D✓�o f J�-{I�,� ���q� <br /> E-maiL• Phone: (� � �J 7�� - 7� �� <br /> � <br /> 3. AgentJCansultant Information <br /> Company Name (if applicable): �i��p�s� �r�;,y„H.,.,���ontact Person:(�J'R�, ��s.c� <br /> Address: �$Z) �,r,,.tbof,(,�..�� City, State, Zip: �„k/�,,,� C�}J M,1V � <br /> S5"�-30 <br /> E-mail: �q�Se1�t�i►/� �.(SN.GAwJ Phone:�/2— b'02-��� <br /> 4. Description of Request <br /> Check all that apply, [�$Wetland Boundary (must attach wetland delineation report) <br /> �Wetland Type (Eggers& Reed and/or Circular 39 type} <br /> 5. Signature <br /> � <br /> By signature below, the applicant requests a determination from the Local Government Unit under i <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 s��bject property or have permission from the ; <br /> landowner to pursue this determination. <br /> �1�z��z <br /> Applica or Aut zed Agent S gnature Date <br /> Important Notes: ', <br /> • The applicant may be required to submit multipfe copies of the report/information to the ', <br /> LGU. The LGU may require the applicant to subrnit copies directly to Technical Evaluation ', <br /> Panel Members. Check with your LGU regarding their submiffa!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 Weiland Boundary/Type Application Form 11/10I08 ' <br />