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� ` ' i1�• • <br /> Variance Application <br /> TOTAL FEE ENCLOSED...... (this fee is for processing of the <br /> appiication and does not <br /> entitle the applicant 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 /> 1 agree to submit a certified, as-built survey upon completion of the docks. <br /> ����������:�;�'v�— �-/2 �D 3. <br /> Authorized Signature Date <br /> �w��. <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�'�1��� �l; i� ;'r�; _ 'I=-;'i <br /> i•/ _ i ti �f, � � �� <br /> I <br /> IIl �Q� 1 �' O ��I�r <br /> Page 3 of3 iJl� Z 03 �� <br /> , �J� <br /> 'J�=�-�_ --._.--i <br />