Minn Wetland Conservation Act Notice of Application-2012

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Minnesota - • Conservation Act Application for Approval of Wetland Type and Boundary 1. Project/Site Information Project/Site Name: 3700 Northern Ave Local Government Unit: Orono Location (address and/or T, R, Sec.): Sec 17, T1 17N R 23W 2. Applicant Information Applicant Name: George Stickney Address: 201 E Lake St City, State, Zip: WAYZATA MN 55391 E-mail: gstickney@cbburnet.com Phone: 952-476-3694 3. Agent/Consultant Information Company Name (if applicable): Svoboda Ecological Resources Contact Person: Franklin J Svoboda Address: 25580 Nelsine Drive City, State, Zip: Shorewood, MN 55331 E-mail: franks@gpsinnovations.com Phone: 952-471-1100 4. Description of Request Check all that apply: 21 Wetland Boundary (must attach wetland delineation report) M Wetland 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 permission from the landowner to pursue this determination. Applicant or Auth rized Agent Signature DAke Important Notes: • The applicant may be required to submit multiple copies of the report/information to the LGU. The LGU may require the applicant to submit copies directly to Technical Evaluation Panel Members. Check with your LGU regarding their submittal requirements. • The LGU decision must be made in compliance with Minnesota Statutes, section 15.99. For LGU use only Date Received: Page 1 of 1 BWSR Wetland Boundary/Type Application Form 11/10/08