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 />PBffcment 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 34*7)3 AVfNUk, S/ClTLS(oR, 6Ts'23l <br />Legal property description ouTLoT />. k^LL^/ COVi£________________ <br />PI D #______go-;i7-33 /a ___________________________ <br />Listed property owner(s) A^^Afumr , <br />v.^TifNfL yvn IP cR *-SifafiA A. Ai c*>/n»Acr <br />Names of abutting lakeshore property owners: <br />(North/WesO_______/w^qt fCNc^f^___________________________________ <br />(Name + Address) <br />(South/East) Q/ift^Lay C?S"3 jf. JL/tir/f srenrTj ijA-'f'Z.ii'rfi, A;a/'6'“5^9/ <br />(Name + Address) <br /># <br />Names of other affected property owners: <br />ctH^nursk.'*-t.AH2>ie£ /Ct^i jStM.t£LS(iR, S'sr33/ <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 />separate group/associatidn owned policy. <br />List the following information: <br />"^Name of insured Ce>vt ^^oMJfcwA/eifiS ^ssocfATtetj 6/^ofie> <br />of insurance carrier <br />fif>fiUcA1'fotJ J Name of insurance agency /^uuu^ <br />Policy No. tfoTser kf/c>wty ______Effective date of coverage <br />/^Amount of coverage: Public liability, per person, per occurrence $ /, too, <br />Fhiblic liability, per occurrence % hoa oo o <br />Page 2 of 5