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� ' • � � � <br /> � � ♦ • • � • • � • � • � � � • � . <br /> _ _----- — <br /> 1. ProjectlSite Information <br /> ProjecUSite Name: 1300 French Creek Drive Local Government Unit: Orono <br /> Location (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, State, Zip: Orono, MN 55391 <br /> E-mail: Phone: <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): svoboda Ecoiogicai Reso�rces 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 /> i <br /> 4. Description of Request <br /> Check all that apply: 0 Wetland Boundary (must attach wetland delineation report) <br /> 0 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 informationn in this applicaiion. <br /> The applicant also affirms that they are the owner of the subject property or have permission frorn the <br /> landowner to pursue this determination. <br /> �`l t� k�' � 1= � •��l'Tl^t�,�l-<:� 'j.wrc.C' 1.`I� C'C'/L', <br /> Applicant or Auth rized Agent Signature Da e— <br /> Irnportant Notes: <br /> • The applicant may be required to subrnit multiple copies of the reporUin'ormation to the <br /> LGU. The LGU may require the applicant to submit copies di�ectly to Technical Evaluation <br /> Panel Members. Check with your LGU regarding fheir submittal requirements. <br /> • Tlie �GU decision must be made in compliance with Minnesota Statutes, section 15.99. <br /> For LGU use only <br /> Date Received: <br /> Page t ol t <br /> BWSR Wetland Boundary/Type Application Form 11i10?08 <br />