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Yellow — Owner
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APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
First
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Last Name
Phone No.Owner:Middle
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g - v?rLake NameLegal Description: Lake No..Lake Class
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If applicant is a coloration, whar state incorporated in
Applicant is: (U) Owner ( ) Occupant { ) Agent( ) Lessee
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
what Section of the Ordinance:
EXPLAIN YOUR PROBLEM HERE:
In order to properly evaluate the situation, please provide as much supplementary information as possible, such as: maps,
plans, information about surrounding property, etc.
19.. XApplication dated.
signature of Applicant
—DO NOT USE SPACE BELOW—
19___Date application filed with Shoreland Management Administration________________________________
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( )Both ( )
ByFiling acknowledgement Signature
Date, time and place of hearing
,, 19____WITH THE FOLLOWINGDEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
day of_
Signature.
Frank Alstadt, President
Otter Tail Planning Advisory Commission
Deviation
Approved this 19day of.. By.
Malcolm K. Lee, Shoreland Management Administrator
Otter Tall County, MinnesotaMKL-0871-016
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159079