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I -5White — Office
Yellovvr— Owner
• Pink -- Township
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
.TOwner:Phone No.
Last Name MiddleFirst
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Street & No.City State Zip No.
Sl-JboLegal Description; Lake No..Lake Name Lake Class
M2SecTwp.Range Twp. Name.
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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.
V •
This application for deviation is from Shoreland Management Ordinance, Otter Tail County, Minnesota for conditonsfound in
what Section of the Ordinance:_____
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In order to properly evaluate the situation, please provide as much supplementary information as |X)ssible, such as: maps,
plans, information about surrounding propter^, etc.
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Application dated.19.. X
ature of Applicant
— DO NOT USE SPACE BELOW—
/eg - y ^ 1.
Date application filed with Shoreland Management Administratioa
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( ) Both
Filing acknowledgement By
Signature
V-V./ T^' 7 7 V! P ti . Qyovoii:^Date, time and place of hearing
CLvn •19 i7 WITH THE FOLLOWINGDEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
day of_
9
AASignature
Chairman 5
Otter Tail Planning Aavlsory Commission
Vr\jL&L^^ X- ^A> e
Malcolm K. Lee, Shoreland Management AdnTinjstrato;^^^.^^r
Otter Tall County, Minnesota
Deviation
Approved this day of rZ 19 By.
MKL-0871-016
171988-A®
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