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Variance Application <br /> TOTAL FEE ENCLOSED...... (this fee is for processing of the <br /> application and does not <br /> entitle the applicant to a variance).................. 500.0 <br /> I certify that the information provided herein and the attachments hereto are true and correct; I understand that <br /> any variance granted may be revoked by the District for violation of the LMCD code. I agree to reimburse the <br /> District for any legal, surveying, engineering, inspection, maintenance or other expenses incurred by the District <br /> in excess of the amount of the application fee. I consent to permitting officers and agents of the District to enter <br /> the premises at reasonable times to investigate and to determine whether or not the Code of the District is being <br /> complied with. <br /> I agree to mit a certi d, as-built survey upon completion of the docks. <br /> �--3� -o'� <br /> Auth iz natu Date <br /> � <br /> Title <br /> Return this application,attachments and fee to: <br /> Relationship to Owner <br /> Lake Minnetonka Conservation District <br /> 18338 Minnetonka Blvd. <br /> Deephaven, MN 55391-3232 <br /> Fax: (952)745-9085 <br /> � � �:- -� <br /> D1 C�J �U� i�; � ��� � j�,i <br /> � <br /> I�; k�i�;l` � 1 �007 �� <br /> uu <br /> By <br /> Page 3 of 3 <br />