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7,c .'se.4 f'{+:.. is iIi7'1irnr? b;r 0.'10 f;_ t::e c, i' <br />cwtier's '?o:i:eC.wner'£ -off icy <br />set arpte owned !:o'.J(- . <br />lint the fo:lloui nC inform Lion: �J <br />natne of insured /l// e,,! <br />:lame of insurance carrier 4"T/Vi9 <br />name of insurance il6ency <br />policy no . nS .� " f ��� e f ctive date of coverage tf 211%S`r <br />amount of coverage; Public liability, per person, per occurence $ J-elr? Ctx) <br />Public lf3bility, cer occurence ,$ • r-C-0lCx> <br />10 • Serurity and _Policing of the jointly used dock and property rty is provided by <br />(check ejcplicable items): <br />fen.ing. + security lighting. ).( property ovnier's presence. <br />contract security service. other (specify) <br />DOCK INFORMATION <br />11. List Dock Use Area Spec ificatiuns: <br />Width <br />of shoreline; —e2 <br />ft. Lena_,t;: <br />of main doclt from shore, <br />di <br />ft. <br />Dock <br />from side <br />property lines <br />a.. <br />shore; 2n ft. and <br />?-0 <br />ft. <br />12. Dock Constructio,. —k epplicable i`e:s): <br />seasonal dock (re_ -1 or re -,)laced each ;;ear). <br />` permanent Filing <br />with su, <br />el <br />deck. <br />pe7^ranent piling and decking. <br />wooden decking. <br />_ J metal <br />do <br />irn, <br />13. List Dock accessories: <br />Number of fire extinguishers nveileb=ce et the dock �J <br />Number cf li-fe i,re: ervers available r, ; the dock <br />14. List number of dips in eech crte,ory ("slims" includes boat Lifts): / <br />Transient (day use ^r_'y) slips � Ti ansient (de;; use) off -shore buoys t "� <br />f'ermnnent moorage siips 1 ermnnent roc rape off-shorebuoys C� <br />Dry storare (rack) sl.ij:s _ i Maximum number of boAts et the dock <br />15. List number of off-street perkir.e, spices available for users of the join' <br />dock. harking, 'f I-m)v ded dust not be sel,arnted from the dock by any publ_' _ <br />spaces. <br />7 n i' <br />