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6.7. <br />9. <br />10. <br />Dock is located on (check applicable item);___one member's private property.easement or outlot owned in common._ property leased by the group/association. X property owned by the group/association,List Dock location and ownership information; ^ <br />Street address — -----------*—j^ <br />Legal property description ^ ^ ---------- <br />PID# - /H - ^ <br />Listed property owner(s) (^/ tLc.— <br />Names/addresses of abutting lakeshore property owners; <br />fNorthAVest')----------------------------------------------- <br />rSouth/Easf <br />Names/addresses of other affected property owners (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 otvned policy. <br />List the following information; <br />Name of insured h—i <br />Name of insurance carrier R.ii <br />fhc\y^ <br />Name of insurance agency 7 f ----Wk'l 0 K.'hc <br />Policy No.(?^iT^£Mi:iii:_ Effective date of coveragd'- <br />/^ount of coverage: Public Hability, per P”s<». P« <br />Security and policing of the jointly used dock and property is provided by (check applicable <br />fencing ____security lighting ^ property owner's presence <br />~ contract security service ____other (specify)------------------------------------ <br />pnr^ information <br />11 . List Dock Use Area Specifications;.^c!- ^ ksf <br />Width of shoreline: _________ ft- Length of main dock from shore; <br />Dock setbacks from side property lines at shore;-------------ft- and <br />Page 2 of 4