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• • � • • � <br /> � � • • • � � • � • � • ' � i• � . <br /> 1. Project/Site Information <br /> ProjecUSite Name: 835 Hunt Farm Rd Local Government Unit: Orono <br /> Location (address and/or T, R, S@C.�: Lot 1,Blk 3 Huntington Farrn Addn,part of lhe 5E Y.SW%SE Y.Section 3U,T118N,R23W <br /> 2. Applicant Information <br /> Applicant Name: Bob Angen Address: PO Box 180 <br /> City, State,Zip: Roberts, WI 54023 <br /> E-mail: boberta50@msn.com Phone: 612-750-4603 <br /> 3. Agent/Consultant Information <br /> Company Name {if applicable): svoboda Ecoiogicai Resources Contact Person: Frank 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: 0 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 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 theyy�re the owner of the subject property or have permission from the <br /> landowner to pursue this determin ti0n. <br /> i � <br /> � r 1 / �.:,cI C�`,�. l l ��' �•7 . <br /> � ".1 ,� ', = ` <br /> Applicant or Authorized ent ignature 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 submitta!requirements. <br /> • The �GU decision must be made in compliance with Minnesota Statutes, section 15.99. <br /> For LGU use only <br /> Date Received: <br /> Page 1 ot 1 <br /> BWSR Wetland Boundary/Type Applicaiion Form 11��fl�08 <br />