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I ' • <br />u. <br />5. <br />6. <br />7. <br />8. <br />(joint Uee Application) <br />Association Is^^checK appllcnble Iteirs): <br />___ unincorporated honeovTier’s group. <br />incorporated Homeowner's Association. / / <br />B t If : <br />unincorporated club or recreation group. ' ' -- <br />incorporated club or recreation group. <br />^ J" 2- /' ^ <br />V .1 J- <br />Principal purpose of Joint use dock is (check applicable i>eM):'' ^ ^ <br />provide boat mooring and lake access for residential prope^. <br />___provide sviaoning access, beach, or offshore dock. / ' ? <br />-----provide a club or association gathering place for _____________________________i <br />Dock is located on (check applicable item): <br />_____ one member’s private property. <br />____ easement or outlot owned in common. <br />___ property leased by the group/essoclation. <br />X property owned by the group/associatlon. <br />Dlst Dock location and ownership information: <br />street address ^ o A^g_ //1, <br />district 38, plat <br />1 ^ ^ ^ <br />parcel <br />listed property ovner(4)*~J/ u fy'J ^// CL^f» •, <br />h-Hu <br />/ <br />property ovner's homeovner ’s policy. <br />__ Beparate group/association owned policy. <br />list the following information: <br />name of insured K H U f\ 'J €► //•/<//c- <br />name of Insurance carrier <br />name of insurance agency <br />policy no. 7 7 V <br />C._, -3T. r <br />/ > /•/- // J_ s fy o ^ k <br />J / <br />effective date of coverage ^ ■—C "^7 "/i’^ <br />amount of coverage; Public liability, per person, per occurance $ 3TT~T;~; <br />Public liability, per occurence ^ /} 5 <br />2 of 4