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/ <br />. < < � <br /> NEW MULTIPLE DOCK, LAUNCHING RAMP,AND/OR <br /> ' � MOORING LICENSE APPLICATION <br /> 1`, Lake Minnetonka Conservation District <br /> ;,,,, .. <br /> • - ---'�`� , 23505 Smithtown Road, Suite 120 <br /> "'^"�''```"�` Shorewood, MN 55331 <br /> ... � <br /> � ' Phone (952) 745-0789 <br /> LMCD Receipt#aC,�i 9/�7 <br /> Because this jorm is to be copied,please use black ink or type. <br /> Pursuant to LMCD Code Section 2.03,a new multiple dock license is requested,in accordance with all data and other information <br /> submitted herewith and made a part hereof. <br /> The person completing this form is the authorized agent or property owner(circle one). <br /> Applicant: .�o I`�! s��"w/��Tz r�t f1-nJ <br /> Address: Y'o�� ��(�c�2�? //?� <br /> City, State,Zip: Ok' O N Q 1t/'� A/ ���` <br /> Phone: 'v1� - �8et-��6 a`'Fax: <br /> Property owner (if different from applicant): <br /> Address: <br /> City, State, Zip: <br /> Phone: Fax: <br /> PROPERTY LOCATION: ,.�— f;.,� <br /> T'he property is located in the city of: Dra�o ,�',� ;,t � r��i� <br /> The property is riparian to LMCD bay/area(s): s+vbbs Bz� `� R� ' ,'� <<` <br /> LMCD Area Identification Number(s): p S 1!7 3 �t 1 oa�3 � Z 3 �� MAR 2 6 2009 � " � <br /> �._�..._._.,....._.... � <br /> 1. Classification of user per Section 2.11, Subd. 2(please circle one : �:;�,____ � <br /> a)commercial marina d) transient rivate residence <br /> , b)private club e) outlot association h) other exp a.�n <br /> ' c)municipal fl multiple dwelling <br /> ' 2. Type of dock construction, describe and attach to-scale drawing: �'oN�� DDGI� ( Sr�hS��IJl�`�� <br /> 3. Please submit names and mailing addresses of owners within a 350-foot radius of the property. <br /> Such owners must be verified by checking with the Hennepin County Auditors Office, (612)348-5910, <br /> ' (or a private abstract company) which can provide actual mailing labels at a cost of$1.25 per tax parcel <br /> (minimum of$25.00). This service usually takes two days, and you must have your tax parcel <br /> identification number(PIN) ready when calling for this assistance. <br /> Page 1 of 3 <br />