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9.
<br />�.:. �• .... �!'. .. V(1: Y' .. n''•f. �! ..:i�. �� .'SF,,i ('('�". .. .., iliilir�. .. 1t C'i,: (:. (.:: C. _ -. l�l.:. _
<br />11 er'., cwner'r
<br />10•
<br />1/ rote
<br />..�i :f.. .,llc fo:!.1o�;i��• i:l_''u:�....';i_an:
<br />naive of insured V/4-", ,^. &c 4 _-
<br />Name of ir.surence c..rrier
<br />name of i nsurs-ince v6ency POLIO(-- I k) i
<br />policy no. y-_ X3- ` C, f j -6, effective date of coverage Uc"a.- Ir tFS_
<br />amoluit or covel'af;e; ; ublic lie: il` ,;,�, r �r r crson, Fer occurence $ Stu) 1,k
<br />Fubllc 1'.nbility, ce. occurence $ Sz>c� r•.
<br />Securi f:y ar.d l:olicirg of the Jointl;; usei ck and _ roverty is 1- r-ovided 'ry
<br />(check epplicpb:ie items) -
<br />fencing. security 1_i=r:tinv. �px-oppertyowner'£> presence.
<br />g• Y L
<br />contract securit.,, service. oth,»• (specify)
<br />DOCK INTKRW,T70:;
<br />11 • List Dock Use Area Spec i ff eativns: Ao <GWA-A,7G f,
<br />Width o" shoreline; /G,r `-i f'L. Lenw.t of main dcc froi:; shore; ? 70r• ft.
<br />Dock setbacks from n1de property lines at shore; Olf'C" ft. and %"�? _ ft.
<br />12. Dock Constr_icticr: (check applicable
<br />r seasonal does (relocated c: rer>iaccd v ch year-
<br />/
<br />penrnnEnt pilirC with senscnel deck. V permanent pil.ini, and decking.
<br />wooden decking;. metel dect_ir:L,
<br />13, List D.)ck Accessories:
<br />Number of
<br />fire
<br />extinguis} ,_
<br />,..i Ili 'r
<br />_,:
<br />r..;, ,:,e docK
<br />U
<br />Nu^:ber of
<br />life
<br />: reserver:
<br />ra_ 1(;b:! e
<br />.
<br />tt e dock
<br />�)
<br />14. L,st number W, i; 7 in eu -. r£ tr. _ ? s' 1-_ .''P�, !:a r+t. :.ifts }
<br />Transient (dal; use only) s1 rf
<br />} e:•:r� vent t*'��:•r�.�e . i j r �
<br />DIy t;tcrar a (ruck) r"• i.1 j'.:
<br />Tz;,n!,i( nt(de'• a e) off -shore buoys
<br />r;:^tle'lt rxll.r1;_.e off -shore buoys
<br />ti;':X SILT, riu,:t'er ('f' bnatr at the dock
<br />i.i.l.t ntt(nLer ofC/ff-siT'eet. {^.Tr,',.e (-(t?%.t'ci ,V,:ii:able f',-r {!fie^f Ui i...� �llilt u'e
<br />dock. Ynrkln.r,, If' ! nivi,ie-! r i, w i. 1"' :.•e:":•)n` i;1P. doc!: I,Y any puoli�
<br />nlnd . - 0 r.,,•lces .
<br />3 u 1' 5
<br />
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