2g. Minnewashta Ski Club: Water Obstacle Permit.04/26/1996 13:33
APR. -26' 96 (FR1) 08:53
612 - 474 -1963
LOFFLER
CENTERLINE SALES
TEL:612 9255181
CARVER COUNTY SHERIFF'S WATER PATROL
600 EAST 4TH STREET
CHASKA; MINNESOTA 55 318
PHONE ( 612 ) 361-1212
PAGE 01
P. 005
I
APR 2 6 7996
M'4N'M -SSFN l SAFETY
RxWzd FOR PERMIT
!OR A TEMPORARY STRVCTURE
The following i n f O rsati On is no essary to insure
proper and accurate issuanee of YOur permit. prase fill
this fors out completely and return it to the above
address. Thank you. ( PLEASE PRINT)
Full wage
Address si
of Birth T =• Gv
Homo Phones 2 4Y1e, work Phone S
Lake s 460St
I HEREBY REQUEST A PERMIT FORS
So-A SIA 400K,,
Mooring Buoy
Floating Raft
Swimming Buoy
Ski Jump
Diving Tower
Slalom Course
Other
lease I ndi cate
PLEASE ATTACH A DIAGRAM OF THE LOCATION OF YOUR STRUCTURE
SHOWING WHERE IT WILL BE PLACED ON THE LAKE INDICATED
ABOVE.
IF IT IS NOT IN FRONT OF YOUR PROPLRTY, ATTACH A ZXTTER OF
PERMISSION. eqi+. f3ob Nnd�l� � lr4l
Upon placement of this temporary structure, I hereby
assume responsibility for its maintenance whi a un r
permit, as well as it removal upon expiratio da
Signature
Date
LI
L
0
0
f
F
M.A. fu Awe
V 04/26/1996
26' 96 (FR1)
13:33 612 -474 -1963
08 :53 LOFFLER
CENTERLINE SALES
TEL :612 9255781
CARVLR CouNTY SHERIFF'S WATER PATROL
600 EAST 4TH OTRZET
cHAexA, M INNESOTA 58 318
PHONE (612) 361 - 1212
REQUEST !'OR PERMIT
FOR A TZM?ORARY STRUCTURE
The following information is necessary to insure
proper and accurate issuance of your permit. Please fill
this form out completely and return it to the above
address, Tha k yqu. (PLEASE" PRINT)
Full Names Date of Birth 7 (jz)
Address YL
Hoare Phones �( ��( Work Phon �1" Z.S
Lake
I HEREBY REQUEST A PERMIT FORS
A /�4 Arwtic�•
v r� tom
Mooring Buoy
Floating Raft
Swimming Buoy
Ski Jump
Diving Tower
Slalom Course
Other
PAGE 02
P. 004
' P eas• n ea e
PLEASE ATTACH A DIAGRAM OF THE LOCATION OF YOUR STRUCTURE
' SHOWING WHERE IT WILL BE PLACED ON THE LAXE INDICATED
ABOVE.
' IP IT IS NOT IM FRONT OF YOUR PROPZRTY, ATTACH A LETTER OP
PERMISSION. �i'...j , IAO. f3J6
' Upon placement of this temporary structure, I hereby
assume responsibility for its maintenance whit under
permit, as well as it removal upon expiration a
' Signature
Date