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^ • <br />. « <br />6. <br />8. <br />9. <br />10. <br />Dock is located on (check applicable item): <br />one member’s private property. ___ property leased by the group/association. <br />easement or outlot owned in common. property owned by the group/association. <br />7. List Dock location and ownership information: <br />Names/addresses of abutting lakeshore property owners]^ <br />(NorthAVesrt C ^ <br />(}^cJCLtxJ(South/EasO <br />Names/addresses of other affected pro ers (attach sheet if necessary): <br />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 />List the following information: • • <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 />Security and policing of the jointly used dock and property is provided by (check applicable <br />items): . V" <br />____fencing X security lighting property owner's presence <br />____contract security service _____other (specify)_________________________ <br />DOCK INFORMATION <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 />Page 2 of 4 <br />1 <br />. I <br />i