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LICENSE APPLICATION-PUBLIC PROPERTY USE Page 2 <br />PUBLIC PROPERTY/USEAGE INFORMATION <br />5. Do you need to grade, fill or otherwise a]J;:..9r the public land to <br />accomodate your proposed use? __ Yes _V-_NNno. <br />a) If yes, state the reason for such alteration: ___________ _ <br />b) If yes, you must attach a detailed land survey of the area to be <br />altered, and appropriate engineering drawings sufficient to identify <br />the extent of arl proposed work. <br />6. Do you intend to install, maintain or keep a pjfiate dock or mooring <br />on or attached to the public land? __ Yes __ V_NNno. <br />a) If yes, state the number of boats to be kept: <br />on land _______ : at the dock _____ : at bouys _____ _ <br />b) If yes, you must attach a sketch of the dock showing the full <br />shoreline width of the public property, the location of the dock, <br />its length and its configuration (straight, L, tee, etc.), and <br />the number of slips. <br />c) If yes, does any other person/property owner have a dock at this <br />location now? Yes (name)__________________ No. <br />d) If yes, is any other person/property owner going to share the dock <br />you build? __ Yes (name)___________________ No. <br />7 . Generally, no building or structure other than a dock, no fence, shed, <br />boat, vehicle, junk or debris shall be permitted to be built, kept, <br />parked or allowed to remain on or within any public land or right-of- <br />way._ If you wish an exception to this law, please state the details <br />and the justification for requesting such an exception: ________ _ <br />8. You must provide your own casualty and liability insurance to cover <br />private useage of the public property. Please contact your insurance <br />carrier/agent to be sure you are covered. Please complete: <br />Insurance Carrier (name)____._~_,_""""'~=-.=..=c::_-------------------r-- <br />Policy No. /(O 5~--06 -~/ X Effective Date ~ <br />Agent (name) --~~~ <br />1 <br />....=.,.""---==---l,,o--=------(Teleph one ) ._? .L/ / -¢ 1/ ,Y y'