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White - Office
■bellow — Owner
Pink — Township
APPLICATION FOR VARIANCE
FROM ’
of Shoreland Management Ordinances Otter Tail County, Minnesota^^^^qujrements
5 First Middle Phone NoGLV^-'Owner:
Last Name
’ Street & No.
■City State Zip No.
JS>St - /VJ Lake ClassLake NameLegal Description: Lake No..
<^9/■fs Twp. NamaRangeSec.Twp.
£Sct
If applicant is a corporation, what state incorfxjrated in____
Applicant is: ^N) Owner ( ) 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
^oi/r. T /ewhat Section of the Ordinance:
EXPLAIN YOUR PROBLEM HERE: .
jILlJjl W ^A3
S iiX^a>xiX- AP
C C
In order to properly evaluate the situation, please provide as much supplementary information as possible, such as: maps,
plans, information about surrounding property, etc.
r Signature of Applicant
r^/19.Application dated.
—DO NOT USE SPACE BELOW—
19___Date application filed with Shoreland Management Administration________________________________
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( )Both ( )
- ByFiling acknowledgement Signature
1^19^2 0) F QcwiGkDate, time and place of hearing ***1
, 19____WITH THE FOLLOWINGDEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
day of_
cREiECTED By 6 m,
•ri
- 9 , InitialsDated:
Signature.
Frank Alstadt, President
Otter Tail Planning Advisory Commission
Deviation
Approved this 19day of.. By.Malcolm K. Lee, Shoreland Management Administrator
Otter Tail County, MinnesotaMKL-0871-016
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