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Variance to Code
<br /> Do�uments listed below are required; check that they are attached:
<br /> ❑ Locator Map (U.S.G.S area map with scale, North direction, Site clearly rrtarlced,
<br /> Narne or Title, LMCD Area Name, LMCD number)
<br /> C? Caunty Plat Map (Site cleariy marked, Name, LMCD area name, LMCD number)
<br /> ❑ Cerfified Land Survey (Legal description, Name, LMCD area name, LMCD
<br /> number, 929.4 N.G.V.D. shoreline)
<br /> ❑ Proposed facility site plan (to scale, 929.4' N.G.V.D. shoreline, LMCD area
<br /> name, LMCD number, Scale, North direction, affected neighbors, locate setback
<br /> area, locate dock use area, location of dock structure with dimensions and slip
<br /> numbers, indicate tyFe of slip if applicable)
<br /> ❑ Existing facility site plan, if applicable (to scale, 929.4' N.G.V.D. shoreline,
<br /> LMCD area name, LMCD number, Scale, North direction, affected neighbors,
<br /> locate setback area, locate dock use area, location of dock structure with
<br /> dimensions and slip numbers, indicate type of slip if applicable)
<br /> ❑ Scaled drawing of docks on abutting properties, and other affected dockage
<br /> Absence of significant data requested above could result in a processing delay.
<br /> FEE CALCULATION `
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<br /> APPL�CATION FEE..........(non-refundable)..........................................$2 , j ;
<br /> DEPOSIT ...... ...............(refundable, upon full compliance � J U L 2 2 1999 �
<br /> with the Code and extent
<br /> of administrative, inspection and y '
<br /> legal service required)....................................+2 .
<br /> TOTAL FEf� ENCLOSED (this fee is for processing of the
<br /> application and does not
<br /> ntitle the applicant to a variance)...................... 500.0
<br /> 1 certify that the infcrmafion provided herein and the attachments hereto are true and torrect; I understand
<br /> that any variance granted may be revoked by the District for violation of the LMCD code. I agree to reimburse
<br /> the Uistrict for any iegal, surveying, engineering, inspection, maintenance or other expenses incurred by the
<br /> District in excess of the amount of the application fee. I consent to permitting o�cers and agents of the
<br /> District to enter the premises at reasonable times to investigate and to determine whether or not the Code of
<br /> the District is being cornplied with.
<br /> I agree rti , a ilt survey upon completion of the daks. �
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<br /> Authorized signature s a
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<br /> Tftle
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<br /> Relationship to owner .
<br /> Return this application, attachments and fee to: Lake Minnetonka �:onservatio� District
<br /> 18338 Minnetonka Blvd.
<br /> Deephaven, MN 55391
<br /> Phone: 745-0789 Fax: 745-9085
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