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. � , � <br /> _=. - - , . u- - • ' � <br /> � ., � . � .n � . - . .- . :. .: <br /> ___ _ ._ _ _ _-- __— _ ---- --__ __--- -- -- ___ _ <br /> 1.Project/Site Information <br /> �, <br /> ProjectlSite Name� `�cc{"1 h E 5,c�����C Local Govemment Unit C�,I�� ���� C��,<�� ��, <br /> Location(address and/or T,R,Sec.): �`IO 5 li F�����H c T)r;v{ <br /> 2.Applicant Information <br /> ApplicantName: �LL/0��� LL� �La���r c/l.c���'4ddress: ��6�� L�u�vy�a�7�����' <br /> City,State,Zip: FGj,n4 /LIN �54Zy <br /> E-mail: �G��ct'qJt(I,p+�11�G, Ca��, Phone: �Iz-�lu U/S Z <br /> 3.AgenUConsultant Information <br /> Company Name(if applicable)� A�+�F r,c u�; 'x,r.��.��c Contact Person: �„�, (,�,��:� <br /> , ,� �rs, �,<< J <br /> Address: �Z:.i (;�,.�E ��i.y. S�v City,State,Zip� �,v.f��K4.�MaSr,���i <br /> E-mail: Phone: 7Z0 ,z 3�_3oy9 <br /> 4.Description of Request <br /> Check all that apply: �1 Wetland Boundary(must attach wetland de6neation report) <br /> ❑Wetland Type(Eggers 8 Reed and/or Circular 39 type� <br /> 5.Signature <br /> By signature belpw,the applicant requests a determination from the Local Govemment Unit under <br /> Minnesota Rules 8420.0225 on the submftted wetland boundary and type information in this application. <br /> The applic�t aiso affirms that they are the owner of the sub�ect property or have permission from the <br /> IandownG(to pursue �s.�/eteymination. <br /> _ � �j <br /> �IC�G(,{{'��'� �// 7-3�—�Z <br /> Applica�t or Aut riho zed Ag nt Signature Date <br /> Important Notes: <br /> . The applicant may be required 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 submittal requirements. <br /> • The LGU decision must be made in compliance with Minnesota Statutes,section 15.99. <br /> � For LGU use only <br /> IDate Received: <br /> Page'1 of 1 <br /> BWSR Wetland Boundaryffype Application Form 11/10lOS <br />