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7. List Dock location and ownership information: <br />8. <br />Street address <br />Legal property description <br />PID# <br />Listed property owner(s) <br />Names/addresses of a^tting lakeshgrc property owners: <br />rNorth/Wesrt \JK U/t t) <br />a^mne laKesn^ property owi <br />C c 4b if Of C71 <br />rSouth/E.ist'V ^ <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 owner's homeowner's policy. __separate group/association owned policy. <br />Name of insured (^ . / - /7 <br />Name of insurance carrier r^, AJ^r* <br />iffectivffda <br />Name of insurance agency ______ <br />I6'7ft ~ 0( ^01' <br />Amount of coverage: Public liability, per person, per occurrence S <br />date of cov <br />n, per <br />Public liability, per occurrence 2^ <br />Security and policing of the jointly used dock and property is provided by (check applicable <br />items): • ^ <br />contract security service ¥ ler (sc(specify) <br />II. DOCK INFORMATION WJ <br />11. List Dock Use Area Specifications: <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 />____wooden decking _____metal decking <br />Page 2 of 4 <br />L