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�� ��` PERMANENT NON-MULTIPLE DOCK LICENSE APPLICATION �' <br /> � r <br /> � ;. Lake Minnetonka Conservation District "�`�` <br /> :�� � 183 3 8 Minnetonka Blvd: - <br /> ' ° `��`=�'�==�� Deephaven, MN 55391 � <br /> rt�:�;;��;���� ' Phone (952) 745-0789 <br /> .�.. � <br /> LMCD Receipt# ��7;.�L <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,instal]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 of a previously <br /> pei�iitced dock whei•e such repair or replacement does not alter the size,type,location,or configuration of the dock. <br /> Because t{:is form is to be copied,please use black ink or type. <br /> The person completing this fonn is the authorized agent or property owner(circle one). <br /> Rpplicant: �UCa;`�'� L-.(F-���I . �N C'__ L � I M �t-'r 1 l��l.��P� ) <br /> Address: y`.�J(� Jt� i_'t_1►...1� ��.1 1 i= <br /> Cit State Zi n <br /> Y> > P� :�s�'..�I h.1�.�1�j?� �`'� tU � ���J�-�- <br /> Phone:�rj')_ ��`i � •• �"5��3 Fax: �ri2� `'}--� I—���pl�� <br /> Pi•operty Owner(if different from applicant): ,�`'.�' E=�.��E� <br /> .--.7 ' <br /> Address 'L-1�GD S-ttl��`l t��'7ti� `�(�� <br /> City, State,Zip: �Q�>�v �h; ';``�j�j� � <br /> Phone: "l(o()� �L)�•- ��(� Fax: ��lo�J� '-4�`�- �L`� 1� <br /> Documents listed below are required; and must accompany this application: <br /> �L,ocator Map ❑Scaled drawing of docks on abutting pr�perties <br /> ❑County Plat Map CJProposed facility site plan <br /> �Certified Land Survey, Legal Description ❑Existing facility site plan <br /> Absen�e of significant requested data, could result in a processing delay. <br /> 1. Ty�e of facility �Q private ()multiple dwelling <br /> () commercial () other(explain) <br /> 2. Intended use of dock facility��q�.�i�,� � �����.��-�"i <br /> 3. Abutting property owners at the lakeshore: <br /> North or West�IrR���E�A�,r.��.5 7�4� S�A_�`,�`c:��c�s� O��^tit��.M'�`S'S=�9� <br /> name end address <br /> South or East �'1� -�U' L�? �.�. �; � M � <br /> name and address O t J <br /> Other affected pafties <br /> name and address FEB d Za05 <br /> 1 of 2 <br /> Sy . <br />