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Yellow — Owner
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
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Pink — Township
L.Phone No.Owner:
Last Name MiddleFirst
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Zip No.StateStreet & No.
Lake ClassLake NameLegal Description: Lake No..
G Twp. NamaRangeTwp.Sec.
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{ ) Agent
If applicant is a corporation, what state incorporated in------
Applicant is: ( ) Owner ( ) Lessee { ) Occupant
List Partner's name and address below:Is Applicant a partnership.
NAME, ADDRESS AND ZIP NO.
V ir no
NAME, ADDRESS AND ZIP NO.
This application for deviation is from Shoreland Management Ordinance, Otter Tail County, Minnesota for conditons found in
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.
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plans, information about surrounding property, etc.
L -A-?19 9^ .Application dated.ignature of Applicant
—DO NOT USE SPACE BELOW
Date application filed with Shoreland Management Administratioa
Deviation requires: Planning Commmission approval ( )Shoreland Management approval only ( ) BotfTV )
ByFiling acknowledgement Signature
Date, time and place of hearing
., w7^ WITH THE FOLLOWINGDEVIATION APPROVED this______
(OR ATTACHED) REOUIREMENTS:
day of.
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Signature.
r rwik AfAtuiJt, Progidant Cnfir^
Otter Tail Planning Advisory Commission
Deviation
Approved this BV.1 '.AAl^l<?^m I^C^^Shor^'nd^^ai^^em^n^ Administrator
Otter Tail County, Minnesota
19day of.
MKL-0871 016
VICTOI LUMDECM 4 CO . eaiHtCOt. rtOOUS 'ALLS. MINN. 159079
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r- o“GRID PLOT PLAN SKETCHING FORM.feet/inches.Scale: Each grid equals
Application for Building Permit Dated
Application for Sewage System Permit Dated
Building Permit Number__________________
Applicant agrees that this plot plan is a part of application (s) ipf^
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Sewage Systepa^ermit Number.
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