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I3ridge i'ermit Application <br /> Other affected pariies <br /> �` namc and address .�e� <br /> 9. Site lake fronta.ges: Z2� feei and �I�G���feet; distance of bridge from site to <br /> site: � 2s feet. <br /> 5. The bridge will be constructed between the extended lot lines of the sites at both ends of the <br /> bridge and will noi be located in the dock use area of anoi:her property. ( )yes �j no. <br /> 6. All required pennits, licenses and approvals have been obtained from the city in which the <br /> pern�anent dock is located, from the DNR and from the MCWD: �yes ( )no <br /> �xplain: <br /> 7. APPlication Fee........................................ $250.00 <br /> �v <br /> Total Fee enclosed.........................................$,2�(�. <br /> I certify that the information provided herein and the a.ttachments hereto are true and correct; I <br /> nnderstand that any license issued may be revoked by the District for violation of the LMCD <br /> Code. I agree to reimburse the District for any legal, surveying, engineering, inspection, <br /> maintenance or other expenses incurred by the District in excess of the amount of the <br /> application fee. I consent to permitting officers and agents of the District to enter the premises <br /> at all reasonable times to investigate and to determine whether or not fl�e Code of the District is <br /> being complied with. <br /> I agree to submi a certified,as- ' surve upon completion of the bridge installation. <br /> _ 1- �- �� <br /> Autbori Signatare Date <br /> r P�� -� �r ��,#nt�r <br /> TiUe <br /> - ����`� ���1�� Return this application,attachments and fee to: <br /> Relationship to Owncr <br /> Lake Minnetonka Conservation District <br /> 18338 Minnetonka Blvd. <br /> Deephaven,MN 55391-3232 <br /> Faz: (952) 745-9085 <br /> 2 of 2 <br />