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Barcode 128
q-5-(^nsWhite - Office
Yellow — Owner
Pink — Township
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
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Last Name f irst / Middle
7/7 - M. 6,'*''' Sf. UohpefcM hi n
Street & No. City* State
31 Phone NoOwner:
Zip No.
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Legal Description: Lake No..Lake Name Lake Class
2Sec.Twp.Range Twp. Name
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If applicant is a corporation, what state incorporated in____
Applicant is: ( HT^wner ( ) 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
3^000
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.
, Vy-1?r /19 ^<.'"C -vrApplication dated.
Signature of Applicant
— DO NOT USE SPACE BELOW—
a-- 1.7 19J75Date application filed with Shoreland Management Administration.
Both (XJDeviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( )
Filing acknowledgement By Signature
As-/f i4<Date, time and place of hearing Tt / XTJ?
DEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
day of_19____I/VI TH THE POLL OWING
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Signature
Chairman
Otter Tail 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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