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R: . , <br /> �� � <br /> � � PERMANENT NON-MULTIPLE DOCK LICENSE APPLICATION <br /> . <br /> '� Lalce Minnetonlca Conservation District <br /> . ;;�'; 18338 Minnetonka Blvd. <br /> " �='�'-° Deephaven, MN 55391 <br /> ...��;._�_ <br /> pt�•fTNYi.t.YF. ' phone (952) 745-0789 � - <br /> 0 ` <br /> LMCD Receipt# oc7. 1�Co�-r.� <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 changed. 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,or configuration of the dock. <br /> Because tl: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: f'.Z%��' .Z�G• �'�'^i n� 1. ���/ne/`� <br /> ,�l.L�'� , <br /> Address: y�',S"o Shsr�/;,,P pr�v� <br /> City, State,Zip: .s�ri r,� Pa�r I�C . �tyi�• SS'3�y <br /> Phone: qsZ-y7I- 8�y� � - Fax: �I v`r�- y�/ --g�y3 <br /> Property Owner(if different from applicant):�,�a� C/os� <br /> Address /zi y c� ,� Idh�rs� Tra;� <br /> City, State,Zip: _Oro�o YN�v � S'5��3�j! <br /> Phone: l-!�s'2-u�s'3-•�) 2(o Fax: <br /> Documents listed below are required; and must accompany this application: <br /> OLocator Map ❑Scaled drawing of docks on abutting properties . <br /> � �County Plat Map ❑Proposed facility site plan <br /> ❑Certified Land Survey, Legal Description ❑Existing facility site plan <br /> Abseizce of significant requested data, could result in a processing delay. <br /> 1. Type of facility �.•private ()multiple dwelling <br /> () commercial ()other(explain) <br /> 2. Intended use of dock facility Boa�' S �"o rBg e <br /> 3. Abutting property owners at the lakeshore: <br /> North or WestSg�p�,t o� +�l�c�t� k�ouxu ,�� 12c�p W��raa Q�-r �� <br /> name and address <br /> �S d f`�-, <br /> South or East v 2--�u W,� � L (S � <br /> name and address <br /> Other affected parties � e 2 G 2007 ` <br /> name and address <br /> 1 of 2 � <br /> �Y---------._..._. ...._._.._.:.�: � <br />