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Office of the Sheriff <br /> <br />Commitment to Excellence <br />William M. Hutton <br />Sheriff <br /> <br />Daniel <br /> <br /> <br />Law Enforcement Center • 15015 62nd Street North — P.O. Box 3801, Stillwater, Minnesota 55082-3801 <br />Phone: 651-430-7600 • Fax: 651-430-7603 • TTY: 651-430-6246 <br />www.co.washington.mn.us <br />Equal Employment Opportunity / Affirmative Action <br />Dan Starry <br />Sheriff <br /> <br />Brian R. Mueller <br />Chief Deputy <br /> <br />APPLICATION FOR WATER SURFACE USE PERMIT <br />To Place a raft, buoy, or other structure on or in the waters of this county pursuant to MN Rules 6110.1800 <br /> <br />Name:___David Strub_____________________ Home#:_6514293053_______Cell#__6514028654________ <br /> <br />Address:_12670 Ingersoll Ave N ____________ Work#:__________________Fax#:____________________ <br /> <br /> __Hugo, MN______________________ Zip Code:_55038_______ <br /> <br />E-Mail:__dave@strubnet.net _______________________________________ <br /> <br />Type of structure:_slalom course_______ Body of water:__Sunset Lake____Dates:_June 25, 2020 - Oct 31, 2020_ <br /> <br />Permit requirements: Applicant shall maintain a comprehensive liability insurance policy in the amount not less than <br />three hundred thousand dollars ($300,000). The policy shall remain in effect for the duration of the effective dates. A <br />Certificate of Insurance must be supplied to the Sheriff’s Office with the permit application. <br />I the undersigned applicant, agree to hold harmless Washington County for any and all claims resulting from the structure <br />specified on this application. <br /> <br />1. Diagram of water surface showing placement of structure, include the depth of the water at the <br />location of the structure. <br /> <br />2. Permit must be issued before structure is placed on or in the water. <br /> <br />3. Floating rafts, swim buoys and mooring buoys must be placed between the permit holder’s property <br />lines as they extend into the water. These structures must be within 100 feet of shore. <br /> <br />4. Structure must display proper reflective material as described in MN State Rule 6110.1800. <br /> <br />5. Permit number must be displayed on the structure using numbers that are at least two inches high <br />and a contrasting color to the area where they are attached. <br /> <br />6. Water ski slalom courses and water ski jumps must be approved annually by the City Council or <br />Township Board where the course will be located, special restrictions may apply. Slalom courses <br />cannot exceed 900 feet in length and must display the permit number on the end floats. Slalom <br />courses and ski jumps cannot be a navigational hazard. Water ski jumps must be lighted during the <br />hours of darkness. <br />City/Township Representative printed name:______________________________________________ <br /> <br /> City/Township Representative Signature:_______________________________________________ <br /> <br /> <br /> <br />Signature of Applicant:____________________________________________Date:_________________ <br />