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s , <br /> � . <br /> Variance Applicafion <br /> TOTAL FEE ENCLOSED...... (this fee is for processing of the <br /> application and does not <br /> entitle the appiicant to a variance).................. 500.00 <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, i spection, maintenance or other expenses incurred by the District <br /> in excess of the amount of the application fee.�j 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 submit a certified, as-built survey upon completion of the docks. <br /> �'�J/�����.���"u— �?-/2 �D 3 <br /> Authorized Signature Date <br /> �cJ�-. <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 /> I�-�"'r^'.,.�... �,.-.." .- ... <br /> i 'i <br /> '�i�;I� �L;, i�= , n; -- �..,,� <br /> �,; - <br /> J , . .� _ . ._.�,�j, <br /> j Jf J MAR I 3 2003 �il � <br /> Page 3 of 3 L J� <br /> ��-�-�==:..:_ti.--W,-..�--._.—f <br />