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- • . - • • � ' <br /> ' � � • • ` • • � � - • � - • : • • . <br /> 1. Project/Site Information <br /> ProjecUSite Name: 3625 Jacobs Mill Road Local Government Unit: MCWD <br /> Location (address and/or T, R, Sec.): T118N, R23W, Sec 32 <br /> 2. Applicant Information <br /> Applicant Name: Kurt Schmid or Steve Sexton Address: 3625 Jacobs Mill Road <br /> City, State, Zip: Orono, MN 55356 <br /> E-mail: steve@minnetonkacustomhomes.com Phone: 612- 386- 4494 <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): Kjolhaug Environmental Contact Person: Melissa Barrett <br /> Address: 26105 Wild Rose Lane City, State, Zip: Shorewood, MN 55331 <br /> E-mail:melissa@kjolhaugenv.com Phone: 952-401-8757 <br /> 4. Description of Request <br /> Check all that apply: X Wetland Boundary(must attach wetland delineation report) <br /> X Wettand 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 they are the owner of the subject property or have permission from the <br /> landow r to pur�ue this de� rmination. <br /> ���-- S z� 13 <br /> Applicant or Authorized Agent 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 wifh 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 /> Date Received: <br /> Page 1 of 1 <br /> BWSR Wetland Boundary/Type Application Form 11/10/08 <br />