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at =74f <br />«s»7/? <74 <br />-ijO-7 <br />s !LO0 <br />ss ipz^1 <br />s U5;.j <br />s <br />f <br />«?00 < <br />s s <br />B O s <br />1 s <br />1 s <br />^ a d s <br />O s <br />S <br />4 <br />s, <br />s. <br />0 s. <br />I5.3XH-s.--------------7 ----------------------- <br />Kmi: <br />v;.:;,;>::/y-->::-.:^<'tes^i <br />ki V: •' '■ V '•'\I;J <br />m'B :J <br />mmn <br />Mis minw <br />V m <br />mmm^ <br />E <br />wii: • <br />'•o ir:^ •■',,• ■■’•'vi. <br />V:'*:!;;'v .-^>' <br />■ <br />; 100 •fc %■ ■'•~:'Sr^:¥li?Mlra <br />'•‘-i <br />.!;. — ■■'.'■V :. V <br />*3111 W«»^:-v:v3i:;= <br />^i^==Vv,: 3 <br />.-• • TrJ- 3 -Evil'll'■^■'4*/^ <br />•;i3V.v::l:3: .'I <br />S» 3 "■' ■ ■ 1 <br />3-U 3 3 4 A-v 'MVV:--3=:-liS^KRI <br />P?»v <br />L'rt^Ofc*i <br />•••.■•/■ <br />^^3 <br />r 33^3^: ;■33*3*3:333333*'.33v?^&v;.43 .,^.''3*3:;v...-,, 3;. ■. ; ^ ..J;^_, ■ , . • ‘ 3 ' ■ 3 ' ,33' ■• :v-4'T»^3:- : •J ' •:•»■■ ■:'• >• •■ 1>'-=;K3%Zy-V£'''i'u:r' •■^- • 3*.3 ■. ■ .* ■■■■■ -3 . ;3^i^iv , ■ . . ■ ,v: ..• !'. - ■* • :.. -33-'3 .33^3:3 3 3=1 3 ** :3.«&»i»yR^3:;:ij-v.fc ; :.:3r^.i:3 3:.;,u,;3 3:i^^^ ■■"■33V-;y^Mlnn««ot« Otoartmtfit of H««mi Environmental Field Services 717 SE Oelewere St. P 0. Sok 9441 Minr««r>olis. Minnesota 55440 6U 523*5335 ^r'^plication for Liconse to Opo'rate a 9 MinufFw^:^■.33■••• If J 4 9 M|ouniufacturad Home Park and/or eajtionai Camping Area <br />3 r^-i;:?.3i33 .33333®** <br />» <br />'3-3333.;3f <br />..i:33;,;,3W; <br />.■•• 33:.>;:l331=4^K\ii6smmm <br />F <br />E <br />E <br />S <br />mfAAny ucens E: <br />(first license issued to Parte or Camp) <br />ANNUAL LICENSE — Year Round (over 6 months): <br />$75 (W for each 50 sites or fraction thereof <br />Seasonal (6 months or less): <br />SI 5.00 for each 10 sites or fraction thereof <br />Maximum of S450.00 <br />$11.25 for each 10 sites or fraction thereof <br />Maximum of S337.50 <br />► <br />► <br />^3i::3'3*-3 <br />P?K3:f*.,3:.*Crt<i <br />SEE REVERSE SIDE FOR FEE SCHEDULE. COMPLETE WORKER'S COMPENSATION SECnON <br />AOO S10.00 LATE PAYMENT FEE IF APPLYING AFTER JANUARY 15 FOR ANNUAL LICENSE OR 15 DAYS AFTER OPEN <br />FOR seasonal operation <br />MAKE CHECK PAYABLE TO: Minnaaota Siata Traaturar <br />3 NCW UCENSi INew Pints must iciicn legat d«ecnpiion el titi. inefudt lil proeeny tor prMem or future ute.l <br />C OWNtRSHIPCHANGI <br />Pptvtoui Ooeretof <br />Laat license no.wes issued for the follovnng quantity of: <br />Mobile Home Sites Independent Camp Sitat <br />NemeolUcaneMiDsrson. Ilmior corppratipiii <br />B iH J^SUiAcJ Vet'g^ra.U^ <br />MeiAine AOdrsis iinchida up eodel <br />Ro. fi<?x €: K c e isic ,■ Y^it^ S S. i si <br />Pin or Comp Tredo Nemo <br />L'^e f" iA 5^ CTa ^ f <br />o« Pits or Camp iQA/f IXACT UXATION ANOrOP OtPiCTlON TO| <br />lilt V*Ui? fcM ___________________Hiefiwy <br />Piftnortfiio Of Corporation «liei OfScon: <br />NAMf <br />/)|av* U,'iS f-' <br />Aoowess <br />I a icC <br />S4 ‘fi <br />Operation: □ Year Round Soeeonei (list opening date and months of operation): I^Ay IS , Si»»c^1^Kv <br />Mobile Home Sites <br />(Note: OoeondoM aiieo irs weiiouc lower oonnecoono.) <br />Mobile Home Sices - Dependent Camp Sites <br />Oaco PurenaseO <br />Dependent Camp Sites <br />Teiepnone <br />4 r J c* *.' i V *4 c'» sS J <br />Poed <br />Townifiio (D V O w\ C Fonome* /r ><'f»)s/av <br />ii i/la Si, ^ i r <br />.55NI-2 <br />Dependent Camp Sitde Independent Camp Sites <br />Independent Camp Sitat <br />Numoer of Fixtures in damral Building if providad:TSh JTSESTS Sh SWSRS"u Ainal S washbasin : <br />Men:///:k. <br />Woman:2./o a. <br />If Primitive Campground list number of privies: <br />(2( privace <br />pj^ private <br />Na of sites with individual water hoolt-upe: <br />No. of sites with indhrtdual sewer hook-ups: <br />You must submit plena in triplicate for new construction or alteration. Ucenae cannot be renewed without this deparmenrs or <br />•pprovel for additional f*tee. You must submit e copy of an approval permit from the municipality or county in which the perk <br />camp is located or e statement from that municipality or county that no permit is required. No license will be issued until <br />requirements have been met. <br />• N .-or3.-'' = ■:>:- 93:'^33^ <br />I <br />ililiiii•33 : =i'i <br />r-^: -V 1 <br />*3fi,i <br />*v 3‘ <br />»*3 3 3: .33v3?^ <br />:>/’ <3333:: 3 :3.:^■33 <br />:v3- ^ <br />i3»33":-^P3,: <br />:’*';3--3**:3-3 3 <br />;■ , , :.;f 33-,:^\v:' - ■ ' 3.' -‘f3 <br />;*«333" ■'*.: 3^ . - '^ :■ <br />» 3'*' = ; -V . .3 : <br />3ife*Sil3^ <br />■3'. <br />3. <br />NfOUSSdl <br />licsnMa't Signatura 3&333:te3.S3 :3 3 ‘ <br />mM- • ISSTOf3 3*5?!^SS'; - I >■- <br />"mjwmwm <br />|R7-r;i‘A3 .*,5:r <br />Wmrnmm^ <br />i»iasws5a;S(ligilt. B k .' 'v ! <br />m <br />''iHli <br />wmm mtt*' <br />" 'C^ <br />i; 3^ <br />a. .3#s|pi <br />tt ■ * w** <br />.pIa* .-;3*e ’*- ■ <br />P^X:3'433.3 <br />fc <■ % <br />ip%ii <br />mmmms, <br />m'W^ <br />. .1 <br />*35:::;;