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BRIDGE PERM7T Al'PLICATION <br /> ,A,,` � Lalte Minnetonka Conservation District <br /> , 18338 Minnetonka Blvd. <br /> .� <br /> � ���"`���,�'\_-�= lleephaven, MN 5539] <br /> �.,.`YL'.�� <br /> MYf tH{1 AN� <br /> ""� . 1'ho��e(952) 745-0789 <br /> ----,--- --- �_--_— _ -- ,�� <br /> LMCD Receipi#� /�`I`io'�. <br /> ln accordance with Section 2.]3 of the LMCD Code,the following application for a bridge license sha11 be completed in <br /> all respects and submiti.ed to the District office.No person may locate,construci,install,or mainLain a bridge on t��e <br /> Lake without first securing a permit iherefor from ihe Executive Director unless there is an exception from the <br /> permitting requirements under Seci;ion 2.]3,Subd.2.A new permit is required whenever the size,type,location,or <br /> coniiguration of the bridge is changed. No new permit is required for repa.ir or replacement of a previously permitted <br /> bridge where such repair or replacement does not alter the size,type,location,or confguration of the bridge.Any <br /> bridge thai is used to tie up or store watercraft shall be regulated as a dock or other structure and not under the <br /> provisions of Section 2.13. <br /> � Because tltis jorm is to be co ied, lease use black i�:k or type <br /> The persoii completing tlus fornl is the authorized agent r property owner(circle one). <br /> Applicant: �� h��1 � • 1�� ���'4 �,r' <br /> Address: ���� .S�c r�w�a� �,� � ,.� <br /> City, Sta.te, Zip: 0(.t r�c� ��J S S �(�S� <br /> Phone: �J�c�-�7�J �� �� Fax: <br /> Property Ovv�ier(if different from applicant):�Q��,�� ��� �a�-�t i�i �3 t 4 �r <br /> r <br /> Address J��/ Y /���qG�� � 1'��� <br /> Cl'ry, Sta.te, ZlP: �/t l't Ol. �!V `7 �� 1 �1 1l �'WGWeSS E � ! �FJ� +� �j,��SY� 1�}�� <br /> Phone: G��r�-� ���i-O �f�`7 Fax: <br /> Documents listed below are required; and must accoinpany this application: <br /> ❑Locator Map ❑Scaled drawing of dockslbridges on abutting properties <br /> � ❑County Plat Map ❑Proposed bridge site pla�i <br /> ❑Certified Land Survey, Lega1 Description ❑Existuig facility site plan <br /> Absence of significant requested data, coul.d result in a processirrg delay. <br /> 1. Type of facility �'private ()multiple dwelling <br /> ()conunercial ()other(explain) <br /> 2. Intended use of bridge: �2�S������y'� '����/►l(� 'j' , � C, r <br /> 3. Abutting o erty owners at the lakeshore: <br /> North or est u I n �-� 1 g �l O r-(.�s�� r���i v.e G�'o v��, N I� <br /> name and address � --,- __ _ _ <br /> sou�n o E�t � o�� S a � �-a v,�-1�� s � � ; , : ; <br /> N <br /> name and address ' <br /> ' �;' JAI� - � 2G06 <br /> 1 of 2 . <br /> ;: „ <br />