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1 -5 191%White — Office
Yellow — Owner
Pink — Township
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
I " 'J/' ' ^ /mrPhone No. 0 ~7 ^^ U1)Tlwner:
Last Name First Middle
N.n.Street & No. >
4CityStateZip No.
QJI-R.yLake Nt>Legal Description:Lake Name Lake Class
4 4oSec.Twp.Range Twp. Nama
If applicant is a corporation, what state incorporated in____
Applicant is: ( ) Owner ( ) Lessee ( ) Occupant ( ) Agent
Is Applicant a partnership
^es or no
NAME, ADDRESS AND ZIP NO.
List Partner's name and address below:
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.
^S_
ly--f Sign^ure of AppMcanT
—DO NOT USE SR^E BELOW—
19 7^Application dated
Date application filed with Shoreland Management Administratioa 19___
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( ) Both ( )
Filing acknowledgement
Date, time and place of hearing ~ 5~- ^ ^ 3 ft ^ ^ P~T~ V-F C\v^ ^ CT' ^ S
SVo537
_ WITH THE FOLLOWING
By
Signature
DEVIATION APPROVED this______
(OR ATTACHED) REOUIREMENTS:
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(jiMjtf 'VkjU4> .
day of_19.
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Signature
Chairman
Otter Tail Planning Advisory Commission
Deviation
Approved this day of.19 . By.
Malcolm K. Lee, Shoreland Management Administrator
Otter Tail County, MinnesotaMKL-0871-016
171988-A®
VICTON LUNOCIN 00.. PMlNTCH*. rCKtUl rALU, MINN.