Laserfiche WebLink
5. <br />6. <br />7. <br />8. <br />9. <br />Principal purpose of joint use dock is (check applicable items): <br />^ 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 />V property owned by the group/association. <br />List Dock location and ownership information: <br />Street address / L <br />Legal property description u. <br />PID# <br />Listed property owner(s) <br />Names of abutting lakeshore property owners: <br />(NorthAVest)<3l^»>_______ <br />(Name + Address) <br />-iSouth/EasO fyt\e,kA€.C U> > }-y PmjV'L <br />(Name + Address) <br />Names of other affected property owners: <br />(Name + Address) (attach sheet if necessary) <br />Insurance Coverage - The jointly used dock is insured by one of the following: <br />____ property owner's homeowner's policy. <br />V separate group/association owned policy. <br />List the following information: <br />Name of insured Payt k%ii h)jj • <br />Name of insurance carrier fr <br />Name of insurance agency ^ t i_______________ <br />Policy No. ^ Effective date of coverage <br />Amount of coverage: Public liability, per person, per occurrence <br />Public liability, per occurrence <br />Page 2 of 5 <br />$