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PEh.,vlANENT NON-MULTIPLE DOCK Lk,;NSE APPLICATION
<br />Lake Minnetonka Conservation District
<br />18338 Minnetonka Blvd.
<br />Deephaven, MN 55391
<br />Phone (952) 745-0789
<br />In accordance with Scc.2.06 of the LMCD Code, the following application for a permanent Dock License shall be
<br />completed in all respects and submitted to the District office. No person may locate, construct, install or maintain a
<br />new permanent dock on the lake without first securing a license providing that no such license shall be required of
<br />docks requiring a license under sec 2.03 of the LMCD Code. A new license is required whenever the size, type,
<br />location, or configuration of the dock is changed. No new license is required for repair or replacement ofa previously
<br />permitted dock where such repair or replacement does not alter the size, type, location, or configuration of the dock.
<br />Because this form is to be copied, please use black ink or type.
<br />The person completing this form is the authorized agent or property owner (circle one).
<br />Address: --~-::J= ..... .:::..u='j_-"'[""1/hc.s.t?_,..j_,_f_-...... l..c:u,:e.·,.,_J<i~e,__:,.'..'S,,_,n:.L· ~,_fr,:_·_Lr _______________ _
<br />C ·t St t z· Exr " · ;J1A1 ,c.-7.,.....7 :?/ 1 y, a e, 1p: -~=-'-'..,_f_,_,_,.,_,o.,_1__,.0='r_~_~-'-"-"--'---'1"'--=-"':..._"'---'-,'=-',c..:_ ______________ _
<br />Property Owner (if different from applicant): ___ ,_h-'-"r ..... ~1-'-?_._h...,.t.,...,?ll==J ________ _
<br />I/Jculingc;dd,res:,. 3S10. Yc:d:. Av'i?l1U(.,.:::>tcHfl /LA.int1eapoll~ MN 55'1l0
<br />Jcb Address :5'.~YO B1'q ls/and ;)fcno /rJN
<br />City, State, Zip: ___________________________ _
<br />Phone: ____ &_1_2_-..... cf~2~,~-~--•~Q~;(p~-·-·7--'-7 ____ Fax: _______________ _
<br />Documents listed below are required; and must accompany this application: _ _ _ l
<br />DL M l ·v,«J D -~ -....-1c--I □s 1 d d . f d k b . . 6 ''lC.6aV•"-ocator ap r • o .. ;i • .J -~\.{,, ca e rawmg o oc s on a uttmg properties o;cv..5
<br />□County Plat Map □Proposed facility site plan
<br />□Certified Land Survey, Legal Description □Existing facility site plan i-.o 11 ':"' Oot k
<br />Absence of significant requested data, could result in a processing delay.
<br />1. Type of facility 9<) private
<br />( ) commercial
<br />( ) multiple dwelling
<br />() other ( explain)
<br />2. Intended use of dock facility ___ ,2:.t..'Y,.!..1.!C.:/)tl"--'/c---'=e'---"li,"'-l-"'a"'-lc .... 'kc..i.-,,(,e!.' l.::..0r:f.!....cff'-•L!m..!.., ...:,O/).,.,/'.c.,.1~il'---=0J-Y ____ _
<br />( V
<br />3. Abutting property owners at the lakeshore:
<br />NorthorWest ?homos 4tj)PiDil frlo r31j /5/01JJ Orun4 Ml\l
<br />/:._ name amfaddress
<br />South or East U@Ot(-..la hbt:ut: 5{/J Big /S1a11d (}f7Jt?u MN
<br />name and address
<br />~12-Gld-1130
<br />t.,12 599'-2<l'3fl
<br />Other affected parties _______________________ _
<br />name and address
<br />1 of2
<br />JAN -7 2005
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