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a t <br /> � � � � • • � � � <br /> � • � . • • � • • • • • •� • i • • . <br /> 1. Project/Site Information <br /> Project/Site Name: Wachman Parcel Local Government Unit: MCWD <br /> Location (address and/or T, R, Sec.): T147N, R23W, Sec 6 <br /> 2. Applicant Information � <br /> Applicant Name: Bill Coffman Address: 201 East Lake Street <br /> City, State, Zip: Wayzata, MN 55391-1695 <br /> E-mail: Phone: <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): Kjolhaug Environmental Contact Person: Melissa Barrett <br /> . Address: 26105 VVild Rose Lane City, State, Zip: Shorewood, MN 55331 <br /> E-mail:melissa@kjolhaugenv.com Phone: 952-401-8757 <br /> � 4. Description of Request <br /> Check all that apply: X 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 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 affirms that they are the owner of the subject properly or have permission from the <br /> landown r to pursue this determination. � <br /> l�/ZZ//� <br /> Applicant or Authorized Agent Signature Date <br /> Important Notes: <br /> • The applicant may be �equired to submit multiple copies of the report/information 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 sUbmitfal 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 Wetland Boundary/Type Application Form 11/10108 <br />