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� f <br /> ' ' Variance Application <br /> TOTAL FEE ENCLOSED...... (this fee is for processing of the <br /> application and does not <br /> entitle the applicant to a variance)................. 500.0 <br /> I certify that the information provided herein and the attachments hereto are true and correct; I understand that <br /> any variance granted may be revoked by the District for violation of the LMCD code. I agree to reimburse the <br /> District for any legal, surveying, engineering, inspection, maintenance or other expenses incurred by the District <br /> in excess of the amount of the application fee. I consent to permitting officers and agents of the District to enter <br /> the premises at reasonable times to investigate and to determine whether or not the Code of the District is being <br /> complied with. <br /> I agree submit a certif , as-built surve n completion of the docks. <br /> � / 4 /�/ <br /> u orized at e Date <br /> rtie <br /> self Retum this application, attachments and fee to: <br /> Relationship to Owner <br /> Lake Minnetonka Conservation District <br /> 5341 Maywood Road, Suite 200 <br /> Mound, MN 55364 <br /> Fax: (952)745-9085 <br /> ;: r5���-�'i:. ::��� �� <br /> ,; ?�:� _, _, , � <br /> ;�� � � ,� <br /> <<, �. � ���� <br /> Page3of3 Q��:_____________ <br />