<p> Iowa Department of Natural Resources Class I Dock Permit Application</p><p> Class I DO NOT USE – FOR OFFICIAL USE ONLY Dock Permit No.______By checking the above box, I certify that Date Issued______Expires______this dock meets the criteria for a Class I ______permit. A Class I dock permit shall be Officer valid only while dock and hoists comply ______with the criteria for a Class I permit. District Supervisor</p><p>I am applying for: (check appropriate box)</p><p> Renewal of existing permit – Give permit number:______ New permit  Change of existing permit – Give permit number and name of present permittee: ______</p><p>Print legibly:</p><p>A. Length of dock from water’s edge to end of dock including F. Number of hoists/slips: ______width of “L” or “T”: ______ft. G. Each dock, hoist, moored vessel and other permitted B. Length of dock from water’s edge to where water reaches structure shall be offset a minimum of 5 feet from an 3 feet in depth: ______ft. adjoining property line and 5 feet from the projection of a line perpendicular from the shoreline at the common C. Width of main dock: ______ft. boundary with adjoining shoreline property. </p><p>D. Dimensions of “L” or “T” portion: (length): ______ft. The shortest distance from any dock, hoist, moored vessel by (width): ______ft. or other permitted structure to adjoining property line. Left: ______ft. Right: ______ft E. Width of lakeshore property at ordinary high water mark: ______ft.</p><p>- Continued on back page -</p><p>1 – 4/9/2007 If this application is for a shared or common dock, provide both names and addresses</p><p>Applicant’s Name</p><p>______(Last) (First) (Initial)</p><p>Applicant’s Permanent Mailing Address:</p><p>______(Street or Box #) (City, State & Zip Code) </p><p>Applicant’s Phone Number(s) and E-mail Address(es):</p><p>______(Phone Number) (E-mail Address - optional)</p><p>911 Address assigned to the property served by the dock</p><p>______(Street) (City, State & Zip Code)</p><p>Name and signature of riparian property owner if other than applicant:</p><p>______(Print Name) (Signature)</p><p>Name of lake or river:______Incomplete or illegible applications will be returned.</p><p>I understand that providing false information automatically makes this dock application invalid and could result in penalties for making a false entry in a public record under Iowa Code 714.8(4).</p><p>______Name Date</p><p>Please send completed application to the appropriate Regional Office where dock is located. Addresses are listed below.</p><p>NW Regional Office SE Regional Office Spirit Lake Fish Hatchery Lake Darling State Park 122 - 252nd Avenue, Spirit Lake, IA 51360 110 Lake Darling Road, Brighton, IA 52540 Phone number: (712) 336-1840 Phone number: (319) 694-2430 </p><p>NE Regional Office NC Regional Office Manchester Fish Hatchery 1203 N. Shore Drive, Clear Lake, IA 50428 22693 - 205th Avenue, Manchester, IA 52057 Phone number: (641) 357-3517 Phone number: (563) 927-3276 </p><p>SW Regional Office SC Regional Office Cold Springs State Park Wallace State Office Building</p><p>2 – 4/9/2007 57744 Lewis Rd, Lewis, IA 51544 502 E. 9th Street, Des Moines, IA 50319 Phone number: (712) 769-2587 Phone number: (515) 281-8174</p><p>3 – 4/9/2007</p>