Laserfiche WebLink
• - • � <br /> � � • � . • • . - C• • <br /> 1. Project/Site Information <br /> Project/Site Name: Local Government Unit: C;�y o� Qrono <br /> Location (address and/orT, R, Sec.): �p� �,,�,���{„�� }�; y�(� �� <br /> 2. Applicant Information <br /> Applicant Name: Nai�l�an �,wn�,� Address:C�01 �1;nw��+�ka K�S��'�s <br /> City, State, Zip: �to v�. (y11`( $S 3 6�e <br /> E-mail: V1VCti�t °' �altioo•C:an'l, Phone: ZI$- 34Fg � 234°� <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): h(/�- Contact Person: <br /> Address: City, State, Zip: <br /> E-mail: Phone: <br /> 4. Description of Request <br /> Check all that apply: �.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,�lplican� t alcq a��s that the�are_���y��_���_�bjscf,.property_Qr have_permission_fr.om the <br /> landowner to pursue this determination. <br /> � 91� 1 ►n <br /> Applicant or Authoriz 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 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 /> Date Received: <br /> Page 1 of 1 <br /> BWSR Wetland Boundary/Type Application Form 11/10/08 <br />