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4 <br /> Site Specific Requirement (Please consult with staff at the Permit and Information Center.) <br /> If wetland soils, plants, or wetland hydrology are present, the property may contain wetland areas <br /> that are regulated by State and Federal law. The applicant is responsible for meeting State/Federal <br /> wetland requirements. If any information indicates that wetlands may be present, the applicant must <br /> submit a professionally prepared wetland determination (stating whether or not wetlands are present) <br /> and a letter of acceptance of the determination from the Oregon Division of State Lands (ODSL). <br /> If regulated wetlands are present on site, the applicant must submit a professionally prepared <br /> delineation of wetland boundaries along with a letter of acceptance of the delineation from the <br /> ODSL. <br /> By signing, the undersigned certifies that he/she has read and understood the <br /> submittal requirements outlined, and that he/she understands that omission of <br /> any listed item may cause delay in processing this application. I (We) the undersigned acknowledge <br /> that the information supplied in this application is complete and accurate to the best of my (our) <br /> knowledge. <br /> OWNER <br /> Signature: <br /> Name (print): Phone: <br /> Address: <br /> City /State /Zip: <br /> REPRESENTATIVE <br /> Signature: Name (print): (print): Debra Delegato, Board President Phone: 747 -6486 <br /> Address: 1200 Gateway Loop <br /> City /State /Zip: Springfield, Oregon 97477 <br /> DESIGNATED CONTACT PERSON <br /> Name: Michelle Lan Phone: 344 - 1165 <br /> Please provide a list of other key contacts, if applicable. <br /> NOTE: This is not a complete list of requirements. Additional information may be required <br /> after further review. <br /> RS:applic.wg <br /> 12/19/94 <br /> Willamette Greenway Permit Application Page 4 of 4 <br />