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,11NN7` PERMANENT NON-MULTIPLE DOCK LICENSE APPLICATION <br /> Lake Minnetonka Conservation District <br /> • 18338 Minnetonka Blvd. <br /> Deephaven, MN 55391 <br /> ?�gnQt��'�a Phone (952) 745-0789 <br /> LMCD Receipt# oc7-21.9,(oc-T) <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: ,f d'c.'� t 2 i C)' 1 A}G• Cr/•Y e,74Lerrter <br /> Address: Is-5o Shsr 4/;n,o Or;vs <br /> City, State,Zip: SPr;req PEW k f mu. 5.63'41 <br /> Phone: 98'2-y7/- 83'-/3 Fax: 96-2 - x/2/ -2393 <br /> Property Owner (if different from applicant): , rad Close <br /> Address /2/y ei t Idhur54 Trail <br /> City, State, Zip: Orono yyi,v 3'531 1 <br /> Phone: q SZ-353-•1) 2-(o Fax: <br /> Documents listed below are required; and must accompany this application: <br /> OLocator Map ❑Scaled drawing of docks on abutting properties <br /> ❑County Plat Map ❑Proposed facility site plan <br /> ❑Certified Land Survey, Legal Description DExisting facility site plan <br /> Absence of significant requested data, could result in a processing delay. <br /> 1. Type of facility CA private ()multiple dwelling <br /> () commercial () other(explain) <br /> 2. Intended use of dock facility Boat 5 t•erale <br /> 3. Abutting property owners at the lakeshore: <br /> North or WestSgupeik oe 1-it.-.I..EoQ 5r 1200 W„-tot/-5-r -pM-i L <br /> name and address <br /> �A�O�Df�LV Iv J 1 — -- - <br /> South or East 2-�u hJ�Lpy�` -� TQC L (( �I I I` I l <br /> name and address �� �� u L/ LL f <br /> Other affected parties I 17 ! 1 <br /> name and address � e X007 ii j <br /> 1of2 - '( <br /> By <br />