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tG, 00White - Office
Yellow — Owner
Pink — Township
APPLICATION FOR V
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
E 73^'3/yfEf^VlA/Owner:Phone No
Last Name First Middle
l^RLL LftKE Fr^uS /^A/sa 7
Street & No.City State Zip No.
GDTniLLegal Description: Lake No..Lake Name Lake Class
1^0iFlU FmoRSec. y Twp.
LoT
Range Twp. Name.
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If applicant is a corporation, what state incorporated in____
Applicant is: ( ) Owner ( ) Lessee ( ) Occupant ( ) Agent
List Partner's name and address below:Is Applicant a partnership
yes or no
NAME, ADDRESS AND ZIP NO.NAME, ADDRESS AND ZIP NO,
This application for deviation is from Shoreland Management Ordinance, Otter Tail County, Minnesota for conditons found in
TmLB Fwhat Section of the Ordinance:
EXPLAIN YOUR PROBLEM HERE:
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In order to properly evaluate the situation, please provide as much supplementary information as possible, such as: maps,
plans, information about surrounding property, etc.
3- /r 19_^^
Application dated.. X
e of Applicant
—DO NOT USE SPACE BELOW—
Date application filed with Shoreland Management Administration.19___
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( ) Both ( )
Filing acknowledgement By
Signature
4~n-80Date, time and place of hearing
DEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
day of.19____WITH THE FOLLOWING
Signature
Chairman
Otter Tall Planning Advisory Commission
Deviation
Approved this day of.19 ■ By.Malcolm K. Lee, Shoreland Management Administrator
Otter Tail County, MinnesotaMKL-0871-016
171988-A®
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