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• • • • � <br /> � • • � • � •�• • • - • • ' • i • � . <br /> 1. ProjecUSite Information <br /> Project`Site Name: ���.�`^��`� ��""�-�'l Local Government Unit: /- �Gw � �oY`"'�vl <br /> J <br /> Location (address and,%or T. R, Sec.): ���p L„ <br /> y�•r��,�VC' D�'o�o .itit�v ��� I <br /> 2. Applicant Information � <br /> Applicant Name: ����a�-, �4� �C✓ � <br /> Address: I <br /> City, State. Zip: � <br /> � <br /> E-mai1: �4�v�e�.�j�.�atiQ���.�v��. Phone: �12 - �7�Iv�- Z.�i� � <br /> � <br /> 3. AgenUConsultant information __—� <br /> Company Name (if applicable): �}�vow�0"��-ti"�'�' Contact Person: ���"{�'� <br /> Address: ?4 0`t I`'�C�S,c��'�' �-`� City, State. Zip: /vl�u�; �ti ss}� <br /> I <br /> E-mail: �j¢�L��vV���,S�e�.�ow1 Phone: 6t2 - Z2j`� � �l4(� <br /> 4. Description of Request I <br /> Check all that apply: �Wetland Boundary(must attach wetland delineation reportj <br /> �Wetland Type (Eqgers& Reed and�or Circular 39 type) <br /> __—. . __----� <br /> 5. Signature <br /> By signature below.the applicant requests a determination from the Local Government Unit under j <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 f <br /> landowner to pursue this determination. <br /> ,Y�-, j���-` ��Z 3�1� <br /> I pA plicant or Authorized Agent Signature Date I <br /> --- --- �J <br /> Important Notes: <br /> • The applicant may be required to submit multiple copies of the report informatian 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 /> --__.._. ___._ <br /> For LGU use onty <br /> Date Received: � <br /> Page 1 of t <br /> BWSR Wstland Boundary.�Type Application Form �1 yp,:pg <br />