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6. <br />8. <br />9. <br />> J9SS0, <br />Dock is located on (check applicable item):___one member's private property.yC easement or outlot owned in common.property leased by the group/association, property owned by the group/association.List Dock location and ownership information: <br />Street address <br />Legal property description <br />PID# <br />Listed property owner(s) <br />Names/addresses of abutting lakeshore property owners: <br />(NorthAVesO y?l. (LU-DK) f y <br />fSouth/EasO / <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 />_j^ 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): <br />_____ fencing ____ security lighting propert>’ owner's presence <br />_____ contract security service _____other (specify)__________________________ <br />DOCK INFORMATION <br />11. List Dock Use Area Specifications: <br />Width of shoreline: ^^(9 ft. Length of main dock from shore: <br />Dock setbacks from side property lines at shore: ________ ft. and _______ <br />Page 2 of 4