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Yellow — Owner
pink — Township
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
Owner;Phone No.
Last Name First Middle
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Street & No. Cfty State Zip No.
Legal Description: Lake No..Lake Name Lake Class
iJjMsDalt-RangeSec. /O Twp.Twp. Name.
If applicant isa corporation, what state incorporated in____
Applicant is: (N») 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
what 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.
Signature of ApplicanT"zApplication dated.
— DO NOT USE SPACE BELOW—
Date application filed with Shoreland Management Administratioa
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( ) Both ( )
Filing acknowledgement By
Signature
Date, time and place of hearing T
DEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
day of.19____WITH THE FOLLOWING
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t,
Signature
Chairman
Otter Tall Planning Advisory Commission
Deviation
Approved this day of.19.. By.
Malcolm K. Lee, Shoreland Management Administrator
Otter Tall County, MinnesotaMKL-0871-016
171988-A®
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