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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).................. 500.00 <br /> 1 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. 1 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 /> ) agree submit a certified, as-built survey upon completion of the docks. <br /> � 5 � <br /> Auth �zed Sign ure Date <br /> � <br /> Title <br /> Return this apptication,attachments and fee to: <br /> Relationship to Owner <br /> Lake Minnetonka Conservatioa District <br /> 18338 Minnetonka Blvd. <br /> Deephaven, MN 55391-3232 <br /> Fax: (952)745-9085 <br /> ! � � (� � � �1 ,��;� ' <br /> �;�f <br /> �i�, �u�v a 5 Zooz �. �t <br /> � � <br /> �� � <br /> Page 3 of 3 _�������.� <br />