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8-zh^hC)> ^APPLICATION ROR VARIANCE
FROM
OTTER TAIL COUNTY, MINNESOTA Receipt No.
Application Fee $
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Phone:/(S/Cx Sht'/sjef
First ^
'UcE'txOwner:
Last N^me Middle
/\/“ ->7 U________City (
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Street & No.State Zip No.&-0. 3 V/yi-Ti
£/sc- h!Lake No.Lake Name Lake Class
^ y 31mSec.Twp.Range Twp. Name
mLegal Description:
3 Fire No.t- f /-32^9
Parcel Number
^S-^-fWK -Gr^ ^ Rp 106) •)
In order to properly evaluate the situation, please provide as much supplementary information as possible, such as: maps, plans,
information about surrounding property, etc. APPLICIANT SHALL BE PRESENT AT THE SCHEDULED HEARING.
I understand that I have applied for a variance from the requirements of the Shoreland Management Ordinance of Otter Tail County.
I understand I must contact my township in order to determine whether or not any additionai variances and/or permits are required
by the township for my proposed project.
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ur&^f Applicant
Application dated
— DO NOT USE SPACE BELOW—
(d ty%_
Date of hearing Time M.f
Court House, Fergus Falls, MN. 56537
DEVIATION APPROVED this
(OR ATTACHED) REQUIREMENTS:
day oL WITH THE FOLLOWING
Signature:
Chairman
Otter Tail Board of AdjustmentMKL 0483 -001
231,616 — Victor Lundeen Co., Printers, Fs'gus Falls, Minnesota
A
:' j Scale: Each grid equals GRID PLOT PLAN SKETCHING FORMfeet/inches
1
Dated:19 Signature
! j Please sketch your lot indicating s/stbacks from road right-of-way, lake and sideyard for each building currently
on lot and any proposed structur
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21598 7®MKL-0871-029
VICTOR lUNDECN CO . PRINTCRS. rCRCUS f*LLS.