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Barcode 128
(p-2|P?8^?RIANCEAPPLICATIO
FROM
OTTER TAIL COUNTY, MINNESOTA Receipt No.
Application Fee $
.T/P.Owner:Phone:
Last Name First Middle
Y)pr>.7“Street & No.State Zip No.
Lake No.Lake Name Lake Class
Sec.Twp.Range Twp. Name
Legal Description:Fire No.
Parcel Number
Explain your request:
erv^CJi-^
(5<7
(3cj8—
Office of County Recorder
County of Otter TaH
I hinliy carfify tM the wittiia Intnh man was AM m A» oMca/(6^recof<i
on Ami^ — day of
kXiJmJjt—, at /^J^o'docS
M
Oowi^ Recorder
_____.Qaputy
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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. 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 additional variances and/or permits are required
by the township for my proposed project.
-Application dated.19,. X
Signature of Applicant
— DO NOT USE SPACE BELOW—
Date of hearing 19.Time M.
Court House, Fergus Falls, MN. 56537
DEVIATION APPROVED this______
(OR A TTACHED) REOUIREMENTS:
day of_19_____WITH THE FOLLOWING
Signature:
Chairman
Otter Tall Board of AdjustmentMKL 0483 -001
231,616 — Victor Lundeen Co.. Printers, Fergus Falls, Minnesota