HomeMy WebLinkAbout17000990829001_Variances_07-03-1974W^ite — Office
Yellow — Owner
Pink — Township
APPLICATION FOR VARIANCE
FROM
Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota
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Street's No. ^
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anLake ClassLegal Description: Lake No..Lake Name
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If applicant is a corporation, what state incorporated in____
Applicant is: (^FOwner ( ) Lessee ( ) Occupant ( ) Agent
yp»t)^es or no
List Partner's name and address below:Is Applicant a partnership.
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
/ CJdC__^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.
Signature of
100J_^]. XApplication dated.
—DO NOT USE SPACE BELOW—
C -c7S'Date application filed with Shoreland Management Administratioa
Deviation requires: Planning Commmission approval ( ) Shoreland Management approval only ( ) Both ( )
Filing acknowledgement By
Signature
y~ 3 ^ 7/f ly ry-uj<tDA ^ D(Ln ■“P?T> ■time and place of hearing
DEVIATION APPROVED this______
(OR ATTACHED) REQUIREMENTS:
day of.19____WITH THE FOLLOWING
REmED By ygzzL sy a>.
4 19^ Initials
Signature
Chairman
Otter Tail Planning Advitory Commission
Deviation
Approved this day of.19 • By.Malcolm K. Lee, Shoreland Management Administrator
Otter Tail County, MinnesotaMKL-0871-016
171988-A®
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5^^GRID PLOT PLAN SKETCHING FORM.feet/inches.Scale: Each grid equals
, 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.
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Sewage System Permit Number.
'X ^ 19 7 <7Dated.Signature
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