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Application Fee $
APPLICATION FOR VARIANCE
FROM
OTTER TAIL COUNTY, MINNESOTAJ
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Last Name First Middle ^ ixsil-
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7 State
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Street & No.City Zip No.
ROi-3 8 0 \A_' .Lake No.Lake Name Lake Class
lb 0 H2. ./3 G2-WSec.Twp.Range Twp. Name
Legal Description:Lot No.Block No.
Sub-Division Name:i-ol / "z -' S Be cJv -/vj Of n
Parcel Number
Explain your problem here:
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EX /-M.
/r? 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.
Application dated.
Applicant
— DO NOT USE SPACE BELOW—
Date of hearing 19 Time M.
Court House, Fergus Falls, MN. 56537
DEVIATION APPROVED this_____
(OR A TTACHED) REQUIREMENTS:
day of_., 19____WITH THE FOLLOWING
Signature:
Chairman
Otter Tail Board of AdjustmentMKL 0483 -001
215601@
VICTO* LU«0t£H CO . PHINTtRS. PtROUS ‘»LLS.
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