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- • • s • ' <br /> ` �� • • ` � • • a • o= . �a : e e , <br /> 1. Project/Site Information <br /> Project/Site Name: 710 Gander Road Local Government Uriit: MCWD <br /> Location (address andlor T, R, Sec.): T117N R23W Sec. 14 <br /> 2. Applicant Information <br /> Applicant Name: Davis Daniels Address: 710 Gander Road <br /> City, Sta�e, Zip: Orono, MN 55391 <br /> E-mail: vxrf9d@aol.com Phane: 952-476-1989 <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): SER Contact Person: Brian Burgner <br /> Address: 25580 Nelsine Drive City, State, Zip: Shorewood MN, 55331 <br /> E-mail: brianb@gpsinnovations.com Phone: 952-4?1-1100 <br /> 4. Description of Request <br /> Check all that apply: C]Wetland Boundary (must attach wetland delineation report) <br /> �Wetland Type (Eggers & Reed and/or Circular 39 type) <br /> 5. Signature <br /> By signature below, the applicant requests a determination frorn 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 s��bject property or have permission from the <br /> landovyner to pursue this��tio <br /> � `� Z� /� �_���c� <br /> Applicant or Au�lSorized'Ager 'Si�n�ture Date - <br /> --�-- —— --— _--------- <br /> Important Notes: <br /> • The applicant may be required to submit multiple copies of the reporUinformation to lhe <br /> LGU. The LGU may require the applicant to submit copies directly to Technical Evaluation <br /> Panel Members. Check wiih your LGU regarding their submittal requirements. <br /> • The LGU decision must be made in cornpliance with Minnesota Statutes, section 15.99. <br /> ____.____ _____ <br /> For LGU use only __ _ . _ _ � � � �� � r_ _ _ _ _ <br /> , �, � <br /> Date Received: <br /> -____--__��___-.-------- --�ll���_. _ _ __ .__ <br /> Page 1 ot 1 <br /> BWSR WeUand Boundary/Type Application Form t t;10i08 <br />