Laserfiche WebLink
Permanent Non-Multiple Dock License Applic�tion • <br /> 4. Site lake frontage:�c_F. ;�o feet; distance of dock into fihe lalce: �� feet. <br /> 5.AlI setbacks for the dock use area have been observed {�()yes O no. <br /> 6.All required permits, licenses and approvals have been obtained from the cifiy in wllicli the <br /> permanent dock is located, and from the DNR: O yes O no <br /> Explain: _...-�- -- - <br /> 7. APAlicatioi7 Fee........................................ $]50.00 <br /> After-the-fact application fee....................$150.00 <br /> Total Fee enclosed.........................................$ <br /> I certify that the information provided herein and the attachments hereto are true and correct; I <br /> understand that any ticense issued may be revoked by the District for violation of the LMCD <br /> Code. T agree to reimburse the District for any legal, surveying, engineering, inspection, <br /> maintenance or other expenses incurred by the District iu excess of the amount of the � <br /> applicafion fee. I consent to permitting officers and agents of the District to enter the premises <br /> at all reasonable times to investigate and to determine whether or not the Code of the District is <br /> being complied with. <br /> I agree to submit rtified,as-built survey upon completion of the docics. <br /> ~� ' " �^/O—�.1� <br /> Authorized Signature Date ' <br /> _ �Phe��( /yl�r���.�Y <br /> Title <br /> �n����� Return this application,attachments and fee to: <br /> ' Relationship fo Owner <br /> , Lake Minnetonka Conservation District <br /> 18338 Minnetonka Blvd. <br /> Deephaven,MN 55391-3232 <br /> � Fax: (952) 745-9Q85 � " <br /> r�.�._...r�,�:.�...,. .�,_o.�.,.,,,.::...,�:,.._ .,t.....,_�.._.�.._...�,__..__ __.�.4�.r...___..�..�._.._ <br /> ._. _ ,.a�_ .�.--...�......_._a,:�.<y �,,.. ...T._.. ..__..___....�., - . , --� <br /> 2 of2 <br />