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^. 3-White — Office
Yellow — Owner
Pink — Township
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
Middlehi
Last Name
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* Owner:Phone No.First
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Street & No.Zip No.
anLegal Description: Lake No..Lake Name Lake Class
/33Sec.Twp.Range Twp. Nama
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If applicant is a corporation, what state incorporated in____
Applicant is: (i-^wner ( ) 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 conditons found in
h“SV6what Section of the Ordinance:_____
EXPLAIN YOUR PROBLEM HERE:A<b
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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.
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. XApplication dated.
Signature of Applicant
—DO NOT USE SPACE BELOW—
\j£>Date application filed with Shordland Management Administration.
BothDeviation requires: Planning Commmission approval { ) Shoreland Management approval only ( )
Filing acknowledgement By
Signatu re
9-2.-7J<, ,T.50 f>Date, time and place of hearing
DEVIATION APPROVED this______
(OR ATTACHED) REOUIREMENTS:
day of_19____WITH THE FOLLOWING
Signature
Chairman
Otter Tail Planning Advisory Commission
Deviation
Approved this day of.19 • By.
Malcolm K. Lee, Shoreland Management Administrator
Otter Tall County, MinnesotaMKL-0871-016
171988-A®
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