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-' i:.�'.:'L. :e ccveI' t;e - T'.!e jointly .:.se.l (Q'... Is insur^G !-.i ono of t::C <br />property owner'shwmecwnerls policy. <br />cepnrate owned _o_icy. <br />=ist the followinc iz!'or:ra*ion:I <br />name of insured <br />Name of insurance carrier Vic'j &"M—L I <br />name of insurance agency <br />policy no. 38 ?)(11 � effective date of coverage <br />amount of coverage; Fublie liatil'_t;; , per rerson, per occurence $ 1, GOG, CC6 <br />Public 1'_ability, Ler occurence $ 1a006006 <br />10• Security and policing of the jointly use_ dock and rrorerty is provided by <br />(check enpliceble items): <br />fencing. Y security lighting. property owner's presence. <br />contract security service. other• (specify) <br />DOCK I!TMPME1TION <br />11. List Dock Use Area Specifications: <br />Hidt•n of shoreline; � f�. Lenzt} of main dock from shore; _ ft. <br />Dock setbacks from side property lines at shore; �_ ft. and ft. <br />12. Dock Construction (check applicable items): <br />seasonal dock (relocated or replaced each year). <br />— _rennanent piling w th seescnal deck. permanent piling and decking <br />x wooden decking. metal deckin.;. <br />13. List Dcck Accessories: <br />Number of fire extinguishers svnileble at the deck <br />Number of life preservers available et the dock G <br />14. List number of slips in each category ("Slips" includes boat lifts): <br />Transient (day use only) slips-. Transient(da;; use) off -shore buoys V <br />Permnent moorage sli;�s permanent moorcCe off-sh(>re buoys <br />Dry storage ( rack) slips �' Maximum number of boats at the deck <br />15. List number of off-street parking spaces available for users of the joint use <br />dock. lmrkine, If provided must not be se;jarr!ted from the dock t r any public <br />rur:d . s;,ecer. . <br />3 of 5 <br />