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6. <br />7. <br />Dock is located on (check applicable item): <br />X one member's private property. <br />easement or outlot owned in common. <br />property leased by the group/association, <br />property owned by the group/association. <br />List Dock location and ownership information: <br />Street address 500 Tonkawa Road __ <br />Legal property description NW 1/4 - SW 1/4, Section 5, Township 117, Range 23 <br />PID#_____________________________________________________________ <br />Listed property owner(s) Dr. Glen D. and Marilyn C. Nelson ___________________ <br />8. Names/addresses of abutting lakeshore property owners: <br />fNorth/WesOMr. & Mrs. Edwin C. Gayg. 460 Tonkawa Rd.. Lon g Lake. MM 55356 <br />fSouth/EasO Mrs. Curtis L. Carlson. 550 Tonkawa Rd.« Long Lake, MN 55356 <br />Names/addresses of other affected prcperty owners (attach sheet if necessary): <br />_______________________None __________________________________________ <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 />10. <br />List the following information: <br />Name of insured nr. C1«»n n. «nH Marilyn r. Nelsnn___________ <br />Name of insurance carrier The American Insurance Co.___________ <br />Name of insurance agency Harris Homeyer Co.. Edina, MH 55424 <br />Policy No. NZA1319205________Effective date of coverage 6/31/94 <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 i^)plicable <br />items): <br />____fencing X security lighting X property owner's presence <br />contract security service other (specify) <br />Note: Dr. Nelson's shoreline Is 396'; the combined shoreline, adding <br />Mrs. Carlson's and Gage's Is 1,242'. <br />DOCK INFORMATION <br />11. List Dock Use Area Specifications: <br />Width of shoreline: 296 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