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6. <br />7. <br />8. <br />\ <br />\ <br />\ <br />\ <br />Dock is located on (check applicable item): <br />y one member’s private property. . . <br />easement or outlot owned in comnion.' <br />property leased by the group/association, <br />property owned by ^e group/^sociation. <br />List Dock location and ownership information: <br />Street address ixru . <br />Legal property description _____ <br />PID# <br />Listed property owner(s)__J_ <br />6/ <br />Names/addresses of abutting lakeshore property owners: <br />(S5i^B/Easrt df / -tt. <br />Names/addresses of other affected property owners (attach sheet if necessary): <br />^ „tr 0^________________ <br />9. I&urance Coverage - The jointly used dock is insured by one of the follov^dng: <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 />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 />DOCK INFORMATION <br />- • . • . .... . <br />11. List Dock Use Area Specifications: ■ ........ ; <br />Width of shoreline: r3t>' ft'Length bfihaih dock from shore:' 36. gg ft. <br />Dock setbacks from side property lines at shore: _________ ft. and '_________ ft. <br />Page 2 of 4