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outroo NEW MULTIPLE DOCK, LAUNCHING RAMP, AND/OR <br /> MOORING LICENSE APPLICATION <br /> Lake Minnetonka Conservation District <br /> o 18338 Minnetonka Blvd. <br /> 44, 0NQ1` Deephaven, MN 55391 <br /> Phone(952) 745-0789 <br /> LMCD Receipt# /7105 <br /> Because this form is to be copied,please use black ink or type. <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 ot-operty owner circle one). <br /> Applicant: -r/9 J . Z€ teck <br /> Address: -1 t I k <br /> City, State, Zip: Vr)f)o V n S5 3 Co V <br /> Phone: QST- y-70-e))aLI Fax: 45-0-q-3°-5-5-- --7 <br /> Property owner(if different from applicant): <br /> Address: <br /> City, State, Zip: D ' <br /> Phone: Fax: MAY 1 Y 2004 <br /> PROPERTY LOCATION: By <br /> The property is located in the city of: Or-0 r j <br /> The property is riparian to LMCD bay/area(s): 1r-o•cCs-c Lae <br /> LMCD Area Identification Number(s): I g <br /> I. Classification of user per Section 2.11, Subd. 2 (please circle o•- • <br /> a) commercial marina d) transient _ private residence <br /> b)private club e) outlot association h) other(explain) <br /> c) municipal f) multiple dwelling <br /> 2. Type of dock constructsQn, describe and attach to-scale drawing: <br /> l�Od�. f7Ne-�pJ, <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 parcel <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 /> Page 1 of 3 <br />