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�'����� <br /> AUG 2 5 2010 ����Pi�gn �I�—I� <br /> � • . - • • . • ` <br /> � •• . • • � •• • . • - . � •- • C• . <br /> 1. Project/Site rnformation <br /> ProjecUSite Name: L��Y''�1 e�O1�� Local Government Unit: �����'�"��� �P`�- <br /> �w..�v�.M+l/ CjS7Ct � �� <br /> Location (address and/or T, R, Sec.): 5���� Scc.���"�111�ti� 22�iL`-� <br /> ��.�y,� C,1�v15�e�5P� 2. Applicant Information <br /> Applicant Name: ��e��ketiea� �v�«Q'� Address: �p\ rza.�-E ���►S�'a <br /> City, State,Zip: �j�vc��c�,S'�`"� MN 5S`�Zc� <br /> E-maii: �'�-�l.��e`2�keh��� .(:8�- Phone: CJ�SZ,- ��^ �i�'�� <br /> 3. Agent/Consultant Information <br /> �, <br /> Company Name(if applicable): �t'�'L`�''�'°' �v Contact Person: �jE��-"'� �'' <br /> Address: 2�us`�Me�`�� ��'�i�� City,State,Zip: <br /> s5'�6`� <br /> E-mail: �ovi� �iY'vcs�...L�e�-.��C,.Gv^v� Phone: �j�2.�23`t-,.{�[� � <br /> 4. Description of Request <br /> Check all that apply: �Wetland Boundary(must attach wetland delineation report) <br /> T�GVetland 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 appiication. <br /> The applicanf also affirrris that they are the owner of the subject property ar have permission from the <br /> landowner to pursue this determination. <br /> . � �s/�a <br /> Appiicant 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 with your LGU regarding their submitta6 requirements. <br /> • The LGU decision must be made in compliance with Minnesota Statutes, section 15.99. <br /> For LGU use only p <br /> Date Received: D <br /> Page 1 of 1 <br /> BWSR Wetland Boundary/Type Application Form 11/10/08 <br /> � <br /> I <br />