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New" <br />City of Gern Lake <br />Heritage Hall <br />4200 Otter Lake Road i Gem Lake, MN 55110 <br />551-747-2790/92.1651-747-2795 (fax) <br />E-mail ci rii:,einlal:en�i7,or +, <br />Permit to Allow Archery Deer Hunting in the City of Gem Lake <br />PERMIT APPLICATION CHECKLIST: <br />To prevent delay, please ensure the, following information is submitted <br />© Application Fee (if paying with cash we can only accept exact. change) <br />Cl $100;00 <br />O wa.04 Security Dcposir (separate check from fi c) <br />❑ 5 Plus Acre Parcel Verified <br />O Bow Hunter -Education Certificate <br />t] DNR Permits <br />❑ Deer Stand Locations/Parcel/81 ilding Location/Shooting Lanes <br />© Bow Hunter Education Certificate <br />Permission is hereby given to <br />owner of the property <br />located at AU t >�L kT�.!►� <br />Gern take, Minnesota, to allow archery deer hunting on the property. <br />A Y <br />The following.guidelides must be. followed or you will be in violation of Ordinance No. 124B: <br />• The Permit to allow archery deer hunting on your property shall run. from <br />to 20 (three week maximum), <br />+ Shooting of the bow and arrow shall be on the following three days of each week only: <br />-F121- 5 L)ly <br />• A copy of this Permit must be displayed on the prerniscs;. rand <br />• Additional requirements of the Gem lake. City council are Iisted on the reverse. side of this Penn it. <br />Date <br />I/we, <br />Date <br />Office Use Only <br />have read and understand the above requirements. <br />5 Plus Acre Parcel Verified ❑ City Council Approved <br />❑ $100.00 Fee Paid Date: <br />❑ OOS Security Deposit ❑ Deer Harvest Report Received <br />❑ Bow Hunters Education Certificate Verified Date. <br />DNR Permits Verified ❑ Security Deposit Returned <br />© Deer stand locations/parcel/buildings location/shooting lanes Date - <br />Archery Deer ElunIiI iPermit Pngc; 1 <br />