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i <br />PKRMANENT NON MULI IPl.E DOCK LICENSE APPLICATION <br />I^akc Minnetonka Conservation District ______ <br />18338 Minnetonka Ulvd. <br />Deephaven, MN 55391 <br />Phone (952) 7450789 <br />IMCDHcvctiMH I <br />liiaccoi(ium:c with See.2.06 oflhc I,MCI) (*odc, the roIltiwjii)( applicution for a pciinanenl l)(x,k Liccie.c jJiall be <br />completed in all ic .s|>cc 4k aik I Kubmiiial in llic l)iMri(4 orOce No person may locale, consinicl, insCall oi iiiaifiUiin a <br />new permarrent dock on tlic lake wIU kiu I fust sccuinif* a license providin|^ Ibal no sik.Ii license sliall Ix! required of <br />dfx ks requiring a license uridcr see 2.03 of Ibc LMC!I) C ikIc A i»cw Iicciiik . is re^iiiircxl wlic-nrver llic si/c, type, <br />l(K:ahon, or corifigiirnlion of IIk! ik>ek is changed. No new licciLsi; is Kxpiiied for rcpaii oi icpliicniicnl of a previously <br />liaiuitlcd dock wlicic such refuiir or replacement docs nol alter the size, Cype, location, or configuralion of the dock. <br />Because this ftprm is to he copied, please use Mack ink or type, <br />Tiic person completing this form is the aiilhori/eci agent or property owner (circle one). <br />Aj)plicanf:-----________________________________________________________________ <br />-------Lukt -S r_______________________________________________Address: <br />Cily, .Stale, Zip:________________/lUJ. J?S^±L__________________ <br />^•lone; ___WfiV____________________Fax: 2- <br />Propeiiy Owner (if diffciciit fiom applicant):______pM-n FetuS. <br />Joh fjiN._____________________ <br />(.’iiy, State, Zip:______________________ <br />riioiic:______(all *KZC> ‘ OL> 77 ____Fax: <br />l>ocunicnts listed below are rcquiictl; and nuj.sf accompany this application: ■ <br />□Ixicator Map □Scaled drawing of docks on abutting properties <br />□County l*lat Map □Projmsed facility site plan <br />□(.ertificd Land Survey, Legal Description □Existing facility site plan Dock <br />Absence of significant ret/uested data, could result in a processing delay. <br />I. Type of facility ^ private <br />( ) coinnieicial <br />( ) multiple dwelling <br />() other (explain) <br />2. Intended use of dock facility _ ^pf(\l4tc. P76dh/nf <br />J. Abutting piojicity ownci.s at flic lakeshorc: <br />Noiihoi Wc.st Ihmia^^Lufy^ui . (fic Onm. ^AJ 6>/?^ <br />liaiiM* amiaddrrn <br />South or Last (jiib/idL -Jihinut .djQ Qn>n.<i. J^N ^ C> U 'iyy 3y <br />luiiiic and addfcxa <br />Other affected paities __ <br />lumic and aildrvsa <br />i of 2 <br />JAN - 7 2005