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APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
9 IWhite — Office
Yellow — Owner
Pink — Township
o.Phone No.Owner:MiddleFirstLast Name
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State Zip No.CityStreet & No.
■ '>Lake ClassLake NameLegal Description; Lake No..
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If applicant is a corporation, what state incorporated in____
Applicant is: ( iTOwner ( ) Lessee ( ) Occupant ( ) Agent
no 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
Ml ^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
/3 19.33Application dated.
—DO NOT USE SPACE BELOW—
q-/6Date application filed with Shoreland Management Administratioa
BothDeviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( )
{'K Filing acknowledgement By Signature
9-/^- ys ^✓CaLLQ.<-Date, time and place of hearing T
DEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
, 19.____WITH THE FOLLOWINGday of_
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REJEOED
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19_^ Initials9- /Dated:
Signature.
Frank Alstadt, President
Otter Tail Planning Advisory Commission
Deviation
Approved this day of.19 • By.Malcolm K. Lee, Shoreland Management Administrator
Otter Tall County, MinnesotaMKL-0871-016
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