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7. List Dock location and owTiership information: <br />Street address __________________ <br />Legal property description <br />PID# <br />Listed property owner(s) <br />8.Names/addresses of abutting lakeshore property oNsoers: <br />rNorthAVesO ^ri-h DlOP.lf <br />fSouth/EasO ____ <br />Names/addresses of other affected property owners (attach sheet if necessary): <br />9.Insurance Coverage - The jointly used dock is insured by one of the following: <br />^ property o\%’ner's homeowner's policy. __separate group/association owned policy. <br />Name of insured _______ <br />Name of insurance carrier _ <br />Name of insurance agency <br />Policy No. ____________Effective date of coverage <br />Amount of coverage: Public liability, per person, per occurrence $_ <br />Public liability, per occurrence $ <br />10. Security and policing of the jointly used dock and property is provided by (check applicable <br />items): <br />____ fencing ^ security lighting ^ property owner ’s presence <br />contract security service ____ other (specify)_______ <br />II. DOCK INFORMATION <br />11. List Dock Use Area Specifications;.^ L <br />Width of shoreline: ft. Length of main dock from shore: <br />Dock setbacks from side property lines at shore: _________ ft. and <br />ft. <br />ft. <br />12. Dock Construction (check applicable items): <br />____ seasonal dock (relocated or replaced each year) <br />____permanent piling with seasonal deck ^ permanent piling and decking <br />____w ooden decking _____metal decking <br />Page 2 of 4