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° ��i, �_. PERMANENT NON-MULTIPLE DOCK LICENSE APPLTCATION � <br /> .- .. <br /> ' Lake Minnetonka Conservation District ��• <br /> - r 18338 Minnetonka Blvd. <br /> �-- Deephaven, MN 55391 <br /> �K . <br /> Phone (952) 745-0789 <br /> . ___--___-___ _-_-______ <br /> LMCD Rcccipt# 1 1•% :�c� <br /> In accordance with Scc2.00 of Yhe LMCD Codc,thc following application ibr a permancnc Dock Liccnsc shall Ue <br /> completed in all respecLs and submitted to the District afiice. No person may locate,construcc,install or maintain a <br /> new permanent dock oi�ihc lakc withouL firsL sccuring a liccnse providing that no such liccnse shall be rcquircd of <br /> docks requiring a]iccnsc undcr scc 2.03 of thc LMCD Code.A new liccnse is required whenever the size,typc, <br /> location,or configuration of the dock is changed. No new liccnse is required for repair or replacement of a previously <br /> permilted dock where such rcpair or replacement does not alter thc size,type,location,or configuration of the dock. <br /> l3ecause ihis form is to be copied,please use bluck ink or type. <br /> The person completing this fonn is the authorized agent or property owner(circle one). <br /> Applicant: /������7�fT���.�� �u�fQd�c; �.�4P��C1�/7ci <br /> Address: .�C%J 1i�/c�� f l_uke �Sfi�at' <br /> City, State, Zip: �c�r%S i�v,� /7�/�,� �-i�3/ <br /> Phone: %�i?- �17�- ���-,�5� Fax: >��-S�7`I�%/ Z- <br /> Property Owner(if different from applicant): _ �it-�? ���l.tS <br /> /✓c.��;r�yad�F��: ?�a�. yout� Ao�rt��te.���� /l�Lrni,rc�fbtls A�IN S5�{/t� <br /> Jr�' Address_�50 BiG /s/�i��l c:�1'c;.o �/� <br /> City, State,Zip: <br /> Phone: i�lZ - ��'Z,�,-• G(��7? Fax: <br /> Documents listed below are required; and must accompany this applicatiou: <br /> ❑Locator Map /�/-�= 8;5:5��=►�� ❑Scaled drawin of docks on abuttin ro erties ''�`"5����'� <br /> g g P l� pccr,s <br /> ❑County Plat Map ❑Proposed faciiity site plan <br /> ❑Cert�ed Land Survey, Legal Description ❑Existing facility site plau R,oll:� D�ci� <br /> Absence of significant requested data, could result in a processi�ag delay. <br /> 1.Type of facility �private ()multiple dwelling <br /> () coirunercial () other(explain) <br /> 2. Intended use of dock facility _ i7Y�lfa fe �ilQ.T lii i���f fYlaC>�i/?r%/ <br /> 3. Abutting property owners at the lakeshore: <br /> North or West�j1Uy.�J�J.t. L.Tr�ii��a �:/D ����i I S/Oh� Dl'z n � N1 n! �v/Z- ��-.//30 <br /> namc an address <br /> South orEast��i/��i�.i' .. �/� ��` -iy� �iCr �5/G/�� dro�c� /L91U �/Z•5�y-Z��� <br /> name and address <br /> Other affected parties <br /> name and address <br /> l of 2 � � <br /> JAh� - 7 2005 <br />