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i':! <br />/ I • w My I <br />• f <br />• s \ <br />7.List Duck locitioa and ownership infiMmation: <br />Street rHmt none assigned <br />Legal inopcrty descii]• t Outlot If Bohns Point Addition <br />PID# 08-17>23>44-0011 <br />Lic!edpnipcrtyownei(s) See attached <br />8.Namea/addresset of abutting lakeahoie property owners: <br />fNorti/We^l See attached______________ <br />fSoulhflBartl See attached <br />• I'r-affected property owners (attach sheet if necessary): <br />none <br />9. hsurance Coverage • Hie jointly i* sed dock is insured by one of the following: <br />^ property owners homeowner'Beolicy. <br />See attached Schedule <br />separate group/association owned policy. <br />NaoM of insured______ <br />Name of inaurance carrier _ <br />Name of insurance agency <br />FPlieyNo.___________Effective date of coverage <br />Amount of coverage: Public liability, per person, per occunn <br />Public liability, per occurrence <br />10. Security and policing of the jointly used dock and property is provided by (check applicable il <br />* fencing ____security lighting ___*_ property owner's presence <br />ract security service other (qpecify) <br />ILJ :fiC) a* <br />II.Lirt Dock Use Am Specifications: <br />Widdi of shoreline:________ft. Length of main dock fiom sli <br />Dock setbacks fiom side property lines at shore:________ft.i <br />re: <br />12.ck Consliuclioo (check applicable items): <br />» seasonal dock (relocated or replaced each year) <br />__permanent piling with seasonal deck _____permanent piling and decking <br />wooden decking metal decking <br />»): <br />Page 2 of 4 <br />J