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•,� y� <br /> MtiNN�T SPECIAL DENSITY LICENSE APPLICATION <br /> P�.. °ti,� Lake Minnetonka Conservation District <br /> � ' ' 23505 Smithtown Road, Suite 120 <br /> � ' Shorewood, MN 55331 <br /> °�,' �,:` Phone(952)745-0789 <br /> vF9�'qT1UY O�S <br /> LMCD Receipt# <br /> Because thts jorm is to be copJed,please use black!nk or typa 77►e jorm may be,/�lled out online and printed <br /> Pursuant to LMCD Code Section 2.05,a Special Density License is requested,in accordance with all data and other <br /> information submitted herewith and made a part hereof. <br /> The person completing this form is the ❑aut6orized agent or ❑property owner(select one). <br /> Applicant: /�/�r s�is'� /�'��ii1G� <br /> Address: .�� /y�fQ ,�f��.¢,�,� Q�• <br /> City, State,Zip: �rp�v I''?/v 5.5.3r'l/ <br /> Phone: qS��y7/-Z�Z�Fax: EmaiL• /1S'/1�triK�r ���i.�ih <br /> Property owner(if different from applicant):_i��► S�ro!`� /�c/'ing <br /> Address: .�j2�2 /(,!X'p�„ 5�,�,r.e Qf: <br /> City, State,Zip:�� /'LJJ�/ .,�5.3q/ <br /> Phone: q52-Y7/-2628' Eax: <br /> PROPERTY LOCATION: <br /> The property is located in the city of: �'�rr�v� <br /> The property is riparian to LMCD bay/area(s): ,�j��,�,y�,S /��n�•l' <br /> l. Classification of user per Section 2.1 l, Subd. 2 (please circte one): <br /> �a)commercial marina ❑d)transient ❑g) private residence <br /> ❑b)private club ❑e)outlot association ❑h)other(exp(ain) <br /> ❑c) municipal ❑fl multiple dwelling <br /> 2. [ntended use of the facility:_/��l�q <br /> 3. Please submit names and mailing addresses of owners within a 350-foot radius of the property. Such <br /> owners must be verified by checking with the Hennepin County Auditor's Office,(612) 348-5910, (or <br /> a private abstract company)which can provide actual mailing labe(s at a cost of$1.25 per tax parcel <br /> (minimum of$25.00). This service usual(y takes two days, and you must have your tax parcel <br /> identification number(P[N) ready when calling for this assistance. <br /> , <br /> D � <br /> 1 of 3 FEB 15 2013 <br /> By <br />