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Yellow — Owner Tink
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
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Phone No.Owner:77Last Name First Middle
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Street & No.City State Zip No.
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//^Legal Description: Lake No..
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Lake Name Lake Class
Igt-C.Twp.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 conditonsfound in
kjt loacJcwhat Section of the Ordinance:
EXPLAIN YOUR PROBLEM HERE: (9 U/ A e. r-/t't-e 7" 0 p/>
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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.
h(o ft i W^Jm.cLfctfcTyJApplication dated.19
Signature of Applicant
—DO NOT USE SPACE BELOW—
(o~/9Date application filed with Shorfiland Management Administration.
Both (^)Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( )
Filing acknowledgement By
Signature
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DEVIATION APPROVED this/~7____________________day of tjcy /c
(OR ATTACHED) REQUIREMENTS:
Date, time and place of hearing
, 19 ^<^W!TH THE FOLLOWING
SCANNED
7
Signatuf®^
Chairman
,^tar Tail Plaifning Advisory Commission
Deviation
Approved this
19..^
day of.• By.Malcolm/k. Lee, Shoreland Management Administrator
Otter Tail County, Minnesota _MKL-0871-016
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Application for Building Permit Dated.
Application for Sewage System Permit Dated,
Building Permit Number_________________
Applicant agrees that this plot plan is a part of application (s) indicated above.
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Sewage System Permit Number.
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Application for Sewage System Permit Dated
Building Permit Number_________________
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