Laserfiche WebLink
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).................. 500.0 <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, 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 /> I agree to submit a certified, as-built survey upon completion of the docks. <br /> �{��� t�;;;�%��r�:n> � Z (a �oa�' <br /> Authorized Signature Date <br /> 1�. DCI� �F£r/rlF ( (���':;'��� <�:. <br /> Title " <br /> � c��K ���%��t<<s� Return this application, attachments and fee to: <br /> Relationship to Owner <br /> Lake Minnetonka Conservation District <br /> 23505 Smithtown Road, Suite 120 <br /> Shorewood, MN 55331 <br /> Fax: (952)745-9085 <br /> 1 _ <br /> � <br /> � MAR 2 � 2G09 <br /> I � <br /> � . <br /> Page 3 of 3 <br />