Laserfiche WebLink
5. <br />6. <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 outlet 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 Ctr\t4^____________ <br />Legal property description _______________ <br />?\D!f l2- <br />Listed property owner(s) <br />Names of abutting lakeshore property owners: <br />(North/w^t) _________ <br />(Name + Afddress) <br />(South/East) <br />(Name + Address) <br />Names of other affected property owners: <br />(Name + Address) (attach sheet if necessary) <br />t * • <br />Insure-cc Coverage - The jointly used dock is insured by one of the following: <br />pr petty owner’s homeowner’s policy, <br />separate group/association owned policy. <br />List the following information: <br />Name of insured yin\ia/fP. of ChVlO <br />Name of insurance carrier klflijt __________ <br />Name of insurance agency JotUdiityVv- ^ ________ <br />Policy No. ___________Effective date of coverage <br />Amount of coverage: Publicliability, per person, per occurrence $ ^nO^WO <br />Public liability, per occurrence $ 60C) VOD <br />Page 2 of 5