Wetland delineation report-2014 - Laserfiche WebLink

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, � - � - • • • � • � . • • � • � � . • - . • •- _ • : • • . 1. Project/Site Information ProjecUSite Name: k�� j,,,,,�.�r„t,,,,,�,� Local Government Unit: C'-��oE��..a D�.(t.�a.r�i.`.�.r Location (address and/orT, R, Sec.): -��-� �23�J NE�/�, e{ Sa�- Zs� — —i 2. Applicant Information ' Applicant Name: �S /,� ;r� � S' G,J GJ:NQ ^]-��Address: �p� �� c�,�� City, state, zip: p,,�,,�oJ �,.� ��-3� j �/vl.,rye �+Mle ar, E-mail: �,i►,ro,r�� - 1�15_ N�-'� Phone: �p3( --1v3 I V �'331 3. AgenUConsultant Information � Company Name (if applicable):T�(pto►•� �n��n�y...�..�ontact Person: �,y�/y� `�"'a�e�f� Address: �$? � �,�y,.,,1v.)�.}�v�,�/ City, State, Zip:�,tiok�H �Ca��,� I"11v , 5�'�-�� E-mail: J d;��b5or•ev►.i�rhs�. G� Phone: ��2--�'�Z —��,1� 4. Description of Request Check all that apply: [�Wetland Boundary (must attach wetland delineativn report) GbWetland Type (Eggers & Reed and/or Circular 39 type) 5. Signature By signature below, the applicant requests a determination from the Local Government Unit under Minnesota Rules 8420.0225 on the submitted wetland boundary and type information in this application. The applicant also affirms that they are the owner of the subject property or have permi:>sion from the landowner to pursue this determination. �o�.�- Applic or Aut ized Agent ignature Date Important Notes: • The applicant may be required to submit multiple copies of the report/information to the LGU. The LGU may require the applican�t to submit copies directly to Technical Evaluation Panel Members. Check with your LGU regarding their submittal require�ments. • The LGU decision must be made in compliance with Minnesota Statutes, sE�ction 15.99. For LGU use only Date Received: Page 1 of 1 BWSR Wetland Boundary/Type Application Form 11/10/08