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� � � � , <br /> � � � � � � � � � � � � � � � � � • <br /> 1. Project/Site Information <br /> � Project/Site Name: 2565 North Shore Drive Local Government Unit: Orono <br /> Location (address and/or T, R, Sec.): Part of S YZ SW '/� SE ;�4 of Section 9 T117N, R23W <br /> 2. Applicant Information <br /> Applicant Name: Jeff Martineau Address: 201 Lake St. Unit 100 <br /> City, State. Zip: Wayzata, MN 55391-1608 <br /> E-mail: jmartineau@cbburnet.com Phone: 952-210-2626 <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): Svoboaa Ecoioqicai Reso��rces Contact Person: Frank Svoboda <br /> Address: 25580 Nelsine Drive City, State, Zip: Shorewood,MN,55331 <br /> E-mail: franks@gpsinnovations.com Phone: 952-471-1100 <br /> 4. Description of Request <br /> Check all that apply: O 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 inlormation in this application. <br /> The applicant also affirms that they are the ow�er of the subject property or have permission from the <br /> landown Pto purs e this determin ion. � ) <br /> , <br /> �/l, �� A�� IL� ��� �'� � ;�� �`/�J��� <br /> �. <br /> Applicant or Authorized Agent ignature Date <br /> Important Notes: <br /> • The applicant may be required to submit multiple copies of the report/information to the <br /> LGU. The LGU rnay 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 Weiland Boundary/Type Application Form 11r10/08 <br />