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I • <br />( <br />A o; ^ i •’wnwDCiil Non-Mulliptc l>«K:k I Jcrnie AppttaHlon <br />4. Site lake frontage: _lgOO[__feet; distance of dock into the lake: ' feet. <br />5. All setbacks for the dock use area have been observed (x) yes ( ) no. <br />6. All required permits, licenses ,t ,-provals have been obtained from the city in which the <br />permanent dock is located, and from the DNR: ( ) ye.-; ( ) no <br />F,x plain:__________________________ <br />7.Application Fee...........................................$150 00 <br />Aftcr-the-faet application Toe.......................$150.00 <br />Total Fee enclosed.......................................j <br />uiSSlLd^hl, hereto arc true and correct: I <br />“** District for any legal, surveying, engineering, inspection. <br />fli’^Jii ” if* pennitling officers a>id agents of l!r l^istrict to enter Uic orciniscs <br />b«iw ‘° " Ihc C»lc of 1!« Dislncl is <br />I agfcc (Osu^iia certified, as-buill survey upon complelion of III ^cks. <br />/-s-6r <br />TlOt <br />Ditc <br />RHiaMiiiap loOinier Return this f'ppliration, attachments and fee to: <br />Lake Minnetonka Conservation District <br />18338 Minnetonka Blvd. <br />Deephavrn. MN 55391-3232 <br />Fax: (952) 745-9085 <br />2 of 2 <br />JAN -7 2005