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�' � <br /> Specia!Densiry Application <br /> 10. Have al( the required permits, licenses and approvals been obtained from the MN DNR and from the <br /> city in which the multiple docks ramp, and/or mooring is located7 <br /> �Yes []Vo: If yes,attach copies now; if no, attach copies when received. <br /> 1 l. Base Fee:..........................................................................................................$300.00 <br /> Plus number of Boat Storage Units(BSU's) X $10.00 ea= $� <br /> Or <br /> For approved Speciai Density License Applications,Net increase in BSU's x $10.00=$� <br /> Total fee enclosed <br /> (This fee is for processing of the application and does not entitle the applicant to a license) $300.00 <br /> [ certify that the information provided herein and the attachments hereto are true and correct; [ understand that any <br /> license issued may be revoked by the District for violation of the LMCD Code. I agree to reimburse the District <br /> for any legal, surveying, engiaeering, inspection, maintenance or other expenses incurred by the District ia <br /> excess of the amount of the application fee. [consent to permitting officers and agents of the District to enter the <br /> premises at all reasonable times to investigate and to determine whether or not the Code of the District is being <br /> complied with. <br /> [agree to sub ' certified,as-built survey upon completion of the docks. <br /> 2-t-�-l3 <br /> 6orized Signsture Date <br /> ���i9e/' <br /> Title <br /> ���/1 Return this applicstlon,attachments and tee to: <br /> Relatlonship to Owner <br /> Lake Minnetonka Conservation District <br /> 23505 Smithtown Road,Suite 1Z0 <br /> Shorewood,MN 55331 <br /> Fax: (952) 745-9085 <br /> � <br /> FEB 15 2013 <br /> 3 of 3 <br /> 8y <br />