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. � <br /> MtiNNET NEW MULTIPLE DOCK,LAUNCHING RAMP,AND/OR <br /> P� °s,� MOORING LICENSE APPLICATION <br /> '' 9 Lake Minnetonka Conservation District <br /> � � 23505 Smithtown Road, Suite.120 <br /> `�°tis ,p�� Shorewood,MN 55331 <br /> ��""°"°�� Phone(952) 745-0789 <br /> LMCD Receipt# <br /> Because this form is to be copied,please ase black ink or typ� <br /> Pursuant to LMCD Code Section 2.03,a new multiple dock license is requested,in accordance with all data and other information <br /> submitted herewith and made a part hereof. <br /> The person completing this form is the authorized agent or property owner(circle one). <br /> Applicant: �� �v� I�[ri� <br /> Address: /y��q ��G.,o✓�r.t►:� �C/!'• <br /> City, State, Zip: �,I �i� � /�/�I .553�t'I <br /> Phone: �jSZ-�T�-�ZS' Fax: Email: /'LS�Kc�i��� rS ;�'� <br /> Property owner(if different from applicant): ���'�.J�m/'� !'�Ja/'i;� <br /> Address: .322 2 ��}�.,, ,G�o�e_ D(; <br /> City, State, Zip:��q�zt', /�/�/ SS..�'/ <br /> Phone• �j$2-y7/-�Z� Fax: <br /> PROPERTY LOCATION: <br /> The property is located in the city of: 0/'0,� <br /> The property is riparian to LMCD bay/area(s): ,Q(b►wnS ,�a S�/�i�rg,er <br /> 1. Classification of user per Section 2.11, Subd. 2 (please circle one): <br /> a) ommercial marina d) transient g)private residence <br /> )private club e)outlot association h)other(explain) <br /> c) municipal fl multiple dwelling <br /> 2. Type of dock construction,describe and attach to-scale drawing: -�pq�/:n� <br /> 3. Please submit names and mailing addresses of owners within a 350-foot radius of the property. <br /> Such owners must be verified by checking with the Hennepin County Auditors Office, (612) 348-5910, <br /> (or a private abstract company)which can provide actual mailing labels at a cost of$1.25 per tax pazcel <br /> (minimum of$25.00). This service usually takes two days, and you must have your tax parcel <br /> identification number(PIN)ready when calling for this assistance. , <br /> N �,..�(�.lt�-?��.���o�v� <br /> � - � L �� �; , ; <br /> �j: <br /> �_�. ,.! ��:; { <br /> Page 1 of 3 EL� <br /> FEB 15 2013 � <br />