Laserfiche WebLink
I - • - • • - • ` <br /> ` • � • • ` • � • • - • • - • : • • . <br />� 1. Project/Site Information <br /> Project/Site Name: 100 Chevy Chase Dr. �ocal Government Unit: City of Orono <br /> Location {address and/or T, R, Sec.): 100 Chevy Chase Dr., A portion of Section 26, T118N, R23W <br />� 2. Applicant Information <br /> Applicant Name: Ed Bierman Address: 505 Ferndale Rd <br /> Ciry, State. Zip: Orono, MN 55356 <br /> E-mail: Phone: 952-475-1526 <br /> 3. Agent/Consuitant Information <br /> Company Name (if applicable): svoboaa Ecoio9�cai Resources Contact Person: Frank Svoboda <br /> Address: 25580 Nelsine Drive City, State, Zip: Shorewood,MN,55331 <br /> E-mail: franks@gpsinnovations.com Phone: 952-471-1100 <br /> 4. Description of Request <br /> Check all that apply: �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 determinaiion 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 deter inatio . <br /> -;�l i D,���/.� <br /> Applicant or Authorized A nt i nature 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 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 Weiland Boundary/Type Application Form 11/10/08 <br />