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7. <br />Principal purpose of joint use dock is (check applicable items): <br />X provide boat mooring and lake access for residential property, <br />provide swimming access, beach, or offshore dock. <br />_____ provide a club or association gathering place for activities. <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 MWk-SW^, Section 5, Township 117. Range .J3 <br />PID#__________________________________________________ <br />Listed property owner(s) Dr. Glen D. Nelson & MarUyn C. Nelaon ---- <br />8. Names of abutting lakeshore property owners: <br />(North/West)Mr. & Mrs. Edwin C. Gage, A60 Tonkawa Road. Lone Lake. MN 55356 <br />(Name + Address) <br />(Cn.ith/Risri Mr. & Mrs. Curtis L. Ca rlson. 550 Tonkawa Road, long Late . MN 55356 <br />(Name + Address) <br />Names of other affected property owners: <br />None <br />(Name -r Address) (atuch sheet if necessary) <br />insurance Coverage - The jointly used dock is insured by one of the following; <br />property owner’s homeowner’s policy, <br />separate group/association owned policy. <br />List the following information: <br />Name of insured Dr. Glen D. & Marilyn C. Melsoa <br />Name of insurance carrier The American Insurance Company --------- <br />Name of insurance agency Harrls-Homeyer Co., Edina. HN 55S_2 ^ <br />Policy No. u7.a ni 9205 Effective date of coverage MIM. <br />Amount of coverage: Public liability, per person, per occurrence $------ <br />Public liability, per occurrence $____ <br />Page 2 of 5