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03-14-1936 12:29 612 473 7033 LMCO P.02 <br />lAKE hlWETONKX CONSIRVATIOH DISTRICT- ' <br />Dock Renowol Application 1996 Page 2 <br />FEE CALCULATION; <br />Base Fee. . . . . . . . ... . . . . . . ... . . . . ... . . . . .. $ 50.00 <br />Humber of WSU x $7.so . . . . . . . . . . . . . . . . . . .- $ <br />TOTAL LICENSE FEE (Non-refundable). . . . . . . . . . . . . . . .- $ <br />THE APPLICATION IS DUE ON OR BEFORE DECEMBER 1995. <br />You may pay in full, or submit a deposit of 20% of the license fee <br />($100 minimum) with your application ON OR BEFORE 12/1/95. <br />PAYMENT SCHEDULE; <br />Total License foe paid with application $ __ _ _ <br />Deposit of 20% of license foe (or $100 minimum) $ ^ <br />LATE FEE SCHEDULE t <br />If application is received AFTER 12/1/95, a late foe of <br />10% of the 20% deposit amount (or $10 min.) must be added._ _ _ _ <br />* or * <br />If application is received AFTER 12/31/95, a late fee of <br />20% of the 20% deposit amount (or $20 min.) must be added*_ _ _ _ <br />a or * <br />If application is received AFTER 2/28/96, a late fee of <br />30% of the 20% deposit amount (or $30 min.) must be added._ _ _ _ <br />* or * <br />If application ia received AriER 3/31/96, a late fee of <br />30% of the FULL LICENSE FEE AMOUNT must be added... . . . .______ <br />TOTAL LICENSE FEE DUE FOR 1996 $ 2o9^ <br />AMOUNT PAID WITH APPLICATION $ _ <br />BALANCE DUE ON OR BEFORE 3/31/96; $ Itol7^y0 <br />t <br />I certify that the information provided herein and the attachments <br />hereto are true and corract. I understand that any license issued may <br />bo revoked by the District for violation of the UfCD Code. I agree to <br />reimburse the District for any legal, surveying, engineering, <br />inspection, maintenance, or othsr expenses required that are incurred <br />by the District in assuring compliancs with the LNCD Code under which <br />this application would be granted. I consent to permitting officers <br />and agents of the District to enter the premises at all reasonable <br />times to investigate and to d^ermine whether or not the Code of the <br />District is being comp^^ ^ j ^ <br />Authorized Signature ^___ _ _ Title <br />Relationship to Own« <br />Return to; Lake Minnetonka Conservation District <br />900 E. Wayzata Blvd, Suite 160, Nayzata MN 55391 473-7033 <br />a