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n7•.�''......':C' .Yf!, mil'. - m, C 1: .. � .'�fl.i C^"... _:. �n51iT�_'� C'... (._ �::'.l' i'. _ .C.\:`. - <br />:over"' c.wner's inu:.:ecwne,'r :•o: ic; <br />rer.•r+rate owned ;•olic•y. <br />Ist the fol?cr:;aZ; information: <br />,,// TI p / <br />name of insured V, e- p r r c,\ C S 44ie5 //amee) Biers <br />:lame of insurance carrier I e Y y'CL /V C7 uC1 �n S. �D l t�1/ <br />name of insa:•s,nce rGer.cy � �� 1V,s 4�40 . 33 -7V2/ <br />policy no. /_ 1� •� .2- "?j effective dPt.e of coverage m -- S-5— 1 <br />amount of coverage; ; ublic lieLil' , r-3r person, <br />Public 1'_nbility, per occurence v <br />10. Secitrity and policing of the jointly used dc�ck and property it t:rovide% <br />(check al,n)icsble items): <br />fencing. _ security lighting. X property owner's presence. <br />contract security service. other (specify) <br />DOCK INMRKATION <br />11• List Dock Use Area Spec ificativns: <br />7 <br />Width of shoreline; 9-0 i';.. Len;zt'r: of' mein dock from shore; - 7b0 ft. <br />S�,0 <br />Dock setbacks from side property lines at shore; ft.. and b �� _ ft. <br />12• Dock Ccnstruetion (check applicable items): <br />seasonal dock (relocated or replaced each year). <br />_ permanent riling with seasonal deck. X permanent pi'_ing and decking. <br />vooden decking. _ ruetal decKinG. <br />13. List Dock Accessories: <br />Number of fire ext;nguishers eveilebae at the dock O <br />Nurlber of life preservers available et the dock C <br />14• List number of sli;-s in each category ("slips" includes boat lifts): <br />Transient (day use only) slips 3 Transient(day use) off -shore buoys <br />Fermenent avocrage slips %> <br />Dry storage (rack) slips <br />Permanent moorage off -shore buoys <br />MoX11nUm number of boats at the dock <br />15. Lift number of off-street parking spaces available for users of the joint use <br />dock. Parking, If provided must not be se;•arated from the dock by any public <br />rz>ed . a;lecef . <br />2 nY <br />