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4��� `�1.,w " _ <br /> � � e 0 � <br /> ` � � o e �' • � o ' o' e • _ o � o a ., <br /> ... - ....�"r ,W .. . ...., �K, _ .»> ..,-� _�, <br /> � 1. Project/Site information <br /> Project/Site Name: 168� Fox Street Local Government Unit: Or'ono <br /> Location (address and/or T. R, Sec.): 1685 Fox 5treet Orono, MN 55356 <br /> 2. Applicant Information <br /> Applicant Name: Nivin Macmillan Address: 1685 Fox Stre�t <br /> City, State, Zip: Orono, MN 553.56 <br /> E-mail: Phone: 952-473-3400 <br /> 3. Agent/Consultant Information <br /> Gompany Name (if applicable): SER Contact Person: Frank Svoboda <br /> Address: 25580 Nelsine Drive City, State. Zip: Shorewood, MN 55331 <br /> E-mail: franks@gpsinnovations.coi�� Phone: 952-471-1100 <br /> ~ 4. Description of Request <br /> Check all that apply: CO Wetland Boundary (must attach wetiand delineation report) <br /> C�Wetland Type (Eggers & Reed and/or Circular 39 type} <br /> 5. Signature <br /> By signalure below, ihe applicanl requesis 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 appiicant also aifirms that ihey are the owner of the subjecl property or have permission from the <br /> landowner to pursue this determinatinn. <br /> �=���,4�Q,u,... 4�.u-�����2. iZG.�.� 3/�1_��1 r� <br /> Applicant or Auth�ized Agent Signature Date �— <br /> Important Notes: <br /> • The applicant may be required to submit muiliple copies of the report/information to the <br /> LGU. Tlie LGU may require the applicanl to submit copies directiy to Technical Evaluation <br /> Panel Members. Check with your LGU regarding their submittal requirernents. <br /> • Tf�e 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 t <br /> BWSR Wetland Boundary;Ty�e Application Form 11/10�08 <br />