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r <br /> IstiNt ,r PERMANENT NON-MULTIPLE DOCK LICENSE APPLICATION <br /> Lake Minnetonka Conservation District <br /> 18338 Minnetonka Blvd. <br /> 1/1 ;,.W4.: Deephaven, MN 55391 <br /> �°�ar1c ` Phone (952) 745-0789 <br /> LMCD Receipt# le yb l <br /> In accordance with Sec.2.06 of the LMCD Code,the following application for a permanent Dock License shall be <br /> completed in all respects and submitted to the District office. No person may locate,construct, install or maintain a <br /> new permanent dock on the lake without first securing a license providing that no such license shall be required of <br /> docks requiring a license under sec 2.03 of the LMCD Code.A new license is required whenever the size,type, <br /> location,or configuration of the dock is changed. No new license is required for repair or replacement of a previously <br /> permitted dock where such repair or replacement does not alter the size,type, location,or configuration of the dock. <br /> Because this form is to be copied,please use black ink or type. <br /> The person completing this form is the authorized agent or property owner(circle one). <br /> Applicant: /Vl/Met-onkr,L tea1j/e. Dre(11%l19 <br /> Address: 6-01.; !tJei± Li L. STY,, ' <br /> City, State, Zip: -, i /Si.0 r� /)'/tI f.533) <br /> Phone: %SZ- 74-9t/ y Fax: y5Z-V7`/--&-7/ 2— <br /> Property <br /> Property Owner(if different from applicant):, h Fye C KSU�l <br /> Address .372 4'uest LukE at. <br /> City, State, Zip: Q/2 /4O / /-7//V <br /> Phone: ei.5-2 `Y7[- -5-5e9 Fax: ?c2 V75-- 74') <br /> Documents listed below are required; and must accompany this application: <br /> ❑Locator Map ❑Scaled drawing of docks on abutting properties hO n <br /> ❑County Plat Map ❑Proposed facility site plan <br /> ❑Certified Land Survey, Legal Description ❑Existing facility site plan <br /> Absence of significant requested data, could result in a processing delay. <br /> 1. Type of facility ()$private () multiple dwelling <br /> () commercial () other(explain) <br /> 2. Intended use of dock facility ASh/'ny (end eeU{i`itY) /720604 <br /> Ifyia ova jt— <br /> 3. Abutting property owners at the lakeshore: <br /> North or West M/:v MSS ei,k)/N 6-4&� .r642. 7 %11a/,9 PD, O�•ff/I�O,Hf�1 ssas"� <br /> name and address <br /> South or East /9 ' 4 clof EL f' SN rOa>5 55.75' Ht:is•rpvg• Ag. Oiec<„r, Mn; , <br /> name and address <br /> Other affected parties <br /> name and address <br /> 1 of2 <br /> JAN 9 Gtia• <br />