Laserfiche WebLink
? <br />)up or <br />not) to <br />)mined <br />HRED <br />K BY <br />r* i t V V <br />«» <br />• ' -I V*. <br />-i.- • **'Tr 1 • C-* <br />•4. 1 •• <br />. U* W . •. J. 1 V-> w’ • <br />•: • . tr <br />7. <br />8. <br />9. <br />Principal purpose of joint use dock is (check applicable items): <br />y 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 />_____ 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 owmership information: <br />Street address r.OiJ\A^ ^ \l^K. <br />Listed property owner(s)S<rr^ <br />Names of abutting lakeshore property owners: . <br /><'Northt''West) VfcO jOcirHA OiT . <br />(South/Eastl <br />(Name + Address) <br />Tow^ A a -2.<v /* lOio/'VUiQ^. \)lj ssx <br />(Name + Address) <br />Names of other affected property owners: i <br />Si<A\.wv.scj>rv 5~r0 /U<yVV> CV. (i)60^o <br />^ iName + Address) <br />Insurance Coverage - ine jomuy used <br />property owner's homeowner ’s policy. <br />f(30 »A( <br />of the following: <br />y <br />^s'^c. y <br />^ separate group/association owned policy. <br />List the following information: <br />Name of insured V) o f)aJVJU/S f~ ^ <br />. J t <br />Policy No. V XSr (*? 7 -o Effective date of coverage S~~/S ~ <br />Amount of coverage: Public liability, per person, per occurrence $ S^6,a«o <br />Public liability, per occurrence $ ,CO e <br />Page 2 of 5