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LpAPPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
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Yellow — Owner
Pink — Township
' OwnPr: R.£LU siiHoPhone No.
Last Name First Middle
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Street & No.City State Zip No.
£4-32£Lake Name £*« LPS"7~Legal Description; Lake No..Lake Class
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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.
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This application for deviation is from Shoreland Management Ordinance, Otter Tail County, Minnesota for conditons found in
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SB / 43/» c<<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.
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19JSTApplication dated.f Sl^ii^fure of Aja'^licant
—DO NOT USE SPACE BELOW—
Date application filed with Shoreland Management Administratioa 19___
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( )Both ( )
Filing acknowledgement By Signature
(o P/ 7: ^.Ai, CocyucxM ooc^.Date, time and place of hearing
no 19^/ W! TH THE POLL OWINGDEVIATION APPROVED this______
(OR A TTACHED) REOUIREMENTS:
day of_
Signature 4^
Cffairman
Otter TaiFPiawwing Adwlaory Commlaalon
M a I c o Im^L^eTShorelandlManagementAd
PAGSBS
Deviation
Approved this ZTcJUWJi- 19_£L. By.CL:day of.
Otter TailMKL-0871-016
171988-A®
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VOffice of County Recorder
County of Otter Tail
1 hereby certify that the within Instrument
was filed in^his office for record on the //
CJ-CiOLL- A.D. 19_£2L, at
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Tib \O//^mday of
o’clock: M.: and was di^L3Proi^^c£^.
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Recorded in
19^Book on pa^^e
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County Recorder
Deputy
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GRID PLOT PLAN SKETCHING FORM.feet/inches.Scales Each grid equals t:
.19.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) indicated above.
19
Sewage System Permit Number.
19Dated.Signature
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