Laserfiche WebLink
Minnesota Wetland Conservation Act <br /> Application for Approval of Wetland Type and Boundary <br /> 1. Project/Site Information <br /> Project/Site Name: 23,3b ,Q,a,,i Local Government Unit: £ 47. ,F a„w,frip <br /> aid:64 <br /> Location (address and/or T, R, Sec.): -fl I r JZz3w swro-of3q- <br /> 2. Applicant Information <br /> Applicant Name: 41;t t;`, A`�,,.t.� Address: 1 pp, ,'�.A.(_Q..4, <br /> City, State, Zip: D-�oJ��! 53-3"7/ <br /> E-mail: W;f t; 414.. 829"'•*:1„Gpyyf Phone: <br /> 3. Agent/Consultant Information <br /> Company Name (if applicable): 1cte40 54..AoContact Person: (,tsar , �`y 00 <br /> Address: F371 � JUc_-K.4 City, State, Zip: en,oic/7,, 4k.fies5. MA./ <br /> E-mail: .1 i►Golo�owt 424V IQ 144 SK•Czy,? Phone: ,/ _ gO Z_6v (,f <br /> 4. Description of Request <br /> Check all that apply: PS Wetland Boundary (must attach wetland delineation report) <br /> ba 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 applicant also affirms that they are the owner of the subject property or have permission from the <br /> landowner to pursue this determination. <br /> / 8'/Zo/ <br /> Applica r Auth d 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 />