HomeMy WebLinkAbout55000990489000_Variances_04-07-1976White - Office
Yellow — Owner
Pink — Township
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
k:0.^' Owner:Phone No
Last Name First Middle
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Street &State Zip No.
Legal Description: Lake No. ~Lake Name Lake Class
Twp. ^/ISec.Range Twp. Name.
If applicant is a corporation, what state incorporated in____
Applicant is: ( ) 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
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.
^.x19.Application dated.7 Signature of A'pplicant
—DO NOT USE SPACE BELOW—
19___Date application filed with Shoreland Management Administration
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only (bH'''””"Both ( )
Filing acknowledgement______
Date, time and place of hearing
By.Signature
DEVIATION APPROVED this______
(OR A TTACHED) REQUIREMENTS:
day of_19____WITH THE FOLLOWING
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Signature
Chairman
Otter Tail Planning Advisory Commission / ”
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^^alcoim K. Lee, Shoreland Management Administrator
Otter Tail County, Minnesota
Deviation
Approved this 7 day of.19.
MKL-0871-016
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TO 3E COMPLETED BY PERSON SYSTEM
I hereby attest that I am familiar with the
minimum standards required by the OTTER TAIL
COUNTY SHORELAND MANAGEMENT ORDINANCE regarding
sewage systems and that I—have-i-nsfeallod- the above system^'^in accordance with those standards.
Legal Description;
3//License No.OwTiOrs Name
^ - 'C C-'P''_Signature of Installer
Dare of Installation t - / 7- 7^
Date
Please return when completed to Shoreland Management Zoning Office
Court House, Fergus Falls, Minnesota 56537
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