Laserfiche WebLink
8 <br />Principal purpose of joint use dock is (check applicable items); <br />provide boat mooring and lake access for residential properu’ <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 ownership information: <br />Street address <br />Legal property description A j <br />PID# fZ. _________________ <br />Listed property owneris) <br />Names of abutting lakeshore property owners; <br />(North/W^t) K&Xi/PJI/A <br />^Name ^ <br />i»^ Artihity TPviUt^ <br />(VuTvO <br />(Name A- Address) <br />(South/East) <br />9. <br />(Name + Address) <br />Names of other affected property owners: <br />__________________ <br />(Name + Address) (attach sheet if necessary) <br />Insurance Coverage • The jointly used dock is injured 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 <br />Name of insurance carrier <br />of <br />— <br />Name of insurance agency ft <br />Policy No. ____Effective date of coverage (P>[pl <br />$6gP|DCO <br />Public liability, per occurrence S OOD <br />Page 2 of 5