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a, rtSSOC <br />5. <br />o. <br />ia^ior. is (chec:< anplicacle i's-s): <br />^ 2 ITTc TC.*1.2 — r.cn0C*"n.2r * 3 <br />incor^or3'C0d Hor.ec ’vner* s Associs -icn. <br />unincorporated club or recreation ^rcun. <br />incorporated club or recreation group. <br />Frinciral oumose oi* Joint *U3e ccci is (onecr.. arp^icao —e «w3!ns)i <br />^ provide boat nccring and la'iie access for residential prcpertv <br />[}i^vide svimiiiiig access^ beach• or ofi*3hore doc.*c. <br />■^jTOvide a club or association gaor.ering place -or act^v.^^es <br />D ock is located on (cnecK applicable iten): <br />one r.esber's pri'.'ate property, <br />easement or outlet owned in common. <br />crocerty leased by the group/asscciation. <br />nronerty owned by the group/association. <br />List Docjc location and ovnersnip iniomation: <br />s-.r==-. =dJr^ss yff/t/S-SS9/ <br />legal property description <br />pID # o9 S3 00<:2^/ <br />listed property ovner(s)XT <br />8. Names of abutting lakeshore property owners; <br />t s!>MfeA^v -^/^r <br />^^ (Name + Address) <br />Cc/!^ <br />(Name + Address) <br />Names of other affected property owners: <br />(Name + Address) (attach sheet if necessary) <br />v|/ <br />C72)/9 aJ ^ <br />2 of 5