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PERMANENT NON-MULTIPLE DOCK LICENSE APPLICATION
<br /> '� � Lake Minnetonka Conservatioil District
<br /> ;,,�;�'���, 18338 Mini�etonka Blvd.
<br /> ' " `� �•� Deephaven, MN 55391
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<br /> F.A'Jk`�iF.t.ANf
<br /> �� , Phone (952) 745-0789
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<br /> LMCD Receipt#
<br /> In accordance with Sec.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 cha�lged. No new license is required for repair or replacement of a previously
<br /> permitted dock where such repair or replacement does not alter the size,type, location,ar configuration of the dock.
<br /> Because O:is 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 /> Applicant: ,/�fA/�/� "�iz�f-:�.c � J���,�aiz-a /�.�•�e�r J o ./
<br /> �z:.1—�izy.ri.9 L ,�� �'�,.a� 3Lc,— �.��1�,4� �a�, /Zo.�J
<br /> Address: �-a A �.� .r—r�S/ �.o �a " � .�.�i ���s�
<br /> City, State, Zip:
<br /> Phone: S��z �/7i ?s�� /Y�� y 7��Fax: _ >.r1 5�7/ S�'7/
<br /> Property Owner(if different from applicant): _ ��f-
<br /> Address
<br /> City, State, Zip:
<br /> Phone: Fax:
<br /> Documents listed below are required; and must accor�pany this application:
<br /> ❑Locator Map �Scaled drawing of docks on abutting properties
<br /> ❑County Plat Map C�'roposed facility site plan
<br /> I��Certified Land Survey, Legal Description C�xisting facility site plan
<br /> Absence of significa�zt requested data, could result in a proeessing delay. �._ ,. j
<br /> (.�C: . � � 2,�OG �
<br /> 1. Type of facility �ivate O multiple dwelling �!
<br /> ( ) commercial ( ) other(explain) _
<br /> ....._- ,---
<br /> JG...�i
<br /> 2. Intended use of dock facility �G�„� Gw��e i2 �G,� i,�o�,2:,,,��-
<br /> �6c.i�
<br /> 3. Abutting property owners at the lakeshore:
<br /> North or West ���,�ar "�/Lst.� /��/L�l� .3 2 3a— G.�s,.tl,a� �",�s� �'o.�J
<br /> name and address
<br /> South or East /2��-q�1.J ,��� c�,.�,r�—., 3 2c„— C�y.�,%4 L �.�� /�"�
<br /> name a��d address '
<br /> Other affected parties
<br /> name a��d address
<br /> 1 of 2
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