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� • � � ' <br /> ' � � • • ' • • • • � • - � : � • . <br /> 1. Project/Site Information <br /> ProjecUSite Name: 1300 French Creek Drive Local Government Unit: Orono <br /> �ocation (address and/or T, R, Sec.): 117N 23W Section 10 <br /> 2. Applicant Information <br /> Applicant Name: Chris Dahl Address: 1300 French Creek Drive <br /> City, 5tate, Zip: Orono, MN 55391 <br /> E-mail: Phone: <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): Svoboda Ecoiogicai Resources Contact Person: Franklin 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 /> O 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 atfirms that they are the owner of the subject property or have permission from the <br /> landowner to pursue this determination. <br /> �`( �lC��YG-�`-"�--' �� 'T1I't`�l't}i!L•tt+ 'j..u.YtQ Z. � <.'C'I� <br /> Applicant or Auth rized Agent Signature D ta e <br /> Important Notes: <br /> • The applicant may be required to submit multiple copies of the reporVinformation 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 1 1110/08 <br />