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�N Il��- 10 <br /> . . . - . � <br /> � • • • i ° • • • � • • � • i • • . <br /> 1. Project/Site Information <br /> ProjecUSite Name: 1925 Fox St. Local Government Unit: ��,,yy�s ����Q� <br /> Location (address and/or T, R, Sec.): Sec 3, T117N, R23W <br /> 2. Applicant Information <br /> Applicant Name: Joanne Watson Address: 1925 Fox St. <br /> City, State, Zip: Orono, MN 55391 <br /> E-mail: jwatson @ blakeschool.org Phone: 612-805-5476 <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): Svoboda Eco�ogical Resources Contact Person: Shannon Johnson <br /> Address: 25580 Nelsine Dr. City, State, Zip: Shorewood, MN 55331 <br /> E-mail: mcshanblair@msn.com Phone: 952-471-1100 <br /> 4. Description of Request <br /> Check all that apply: �Wetland Boundary(must attach wetland delineation report) <br /> 0 Wetland Type (Eggers & Reed and/or Circular 39 type) <br /> 5. Signatu�re <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 affi ms that they are the owner of the subject property or have permission from the <br /> land w r to pursue his�deter 'nation. <br /> ---, � �� Z�C 0 <br /> pplicant or Authorized,Agent 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 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: 010 <br /> Page 1 of 1 <br /> BWSR Wetland BoundarylType Application Form 11/10/08 <br />