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6 ^5^7O\0K i
1078S47 OFFICE OF COUNTY RECORDER
OTTER TAIL MINNESOTA
I hereby certify that i078847
this instrument #____________
was filed/recorded jn this office
for reasrd on the n day oL
2010 atWendy7. Metcalf,^oun1(y
by:Vj b -LOci-P recording fe^
^ well certificane
pm
leader ^ ^D^puty
THE ABOVE SPACE IS RESERVED FOR THE COUNTY RECORDER
APPLICATION FOR VARIANCE
COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER
540 WEST FIR, FERGUS FALLS, MN 56537
(218) 998-8095
Otter Tail County’s Website: www.co.ottertail.mn.us
M11 w
& resoukce 4^!)6 ■ DOApplication Fee
COMPLETE THIS APPLICATION IN BLACK INK Receipt Number
Accepted By / Date /byI'Ho
7). 7^-
SECTION 0 I TOWNSHIP RANGE 3°\ TOWNSHIP NAME
600 6\ 000^ 00^
PROPERTY OWNER DAYTIME PHONE
mAJMAILING ADDRESS f
MiLAKE NUMBER LAKE NAME ______LAKE CLASS
PARCEL
NUMBER
E-911
ADDRESS
LEGAL DESCRIPTION
g' 300' o-^ W ^0^' o-f' S o-f
9^ Bo
TYPE OF VARIANCE REQUESTED (Please Check)
structure Setback Structure Size Sewage System ClusterSubdivision Misc.
SPECIFY HOW YOUR PROJECT VARIES FROM ORDINANCE REQUIREMENTS. PLEASE BE BRIEF AS
THIS WILL BE USED FOR PUBLIC NOTIFICATION. . . _ . - /?
I UNDERSTAND THAT I HAVE APPLIED FOR A VARIANCE FROM THE REQUIREMENTS OF THE SHORELAND
MANAGEMENT ORDINANCE/SUBDIVISION CONTROLS ORDINANCE OF OTTER TAIL COUNTY.
I ALSO UNDERSTAND THAT OTHER PERMITS MAY BE REQUIRED, IT IS MY RESPONSIBILITY TO CONTACT LAND &
RESOURCEJHAN,NT REGARDING THIS MATTER.
V
X Slfe'NAffjR^ OF PROPERTY OWNER / AGENT FOR OWNER DATE
APPLICANT MUST BE PRESENT AT THE HEARING , _(Applicant Will Receive Notification As To The Date/Time Of
(pO/Q ‘Date Of Hearing Time
Motion
Daniel D. Peterson - Approved the variance application as requested. (6:50 p.m.)
After consideration and discussion, Michael Harris made a motion, seconded by Joe Maske and unanimously carried, to declare
the East 300’ of the West 805’ of the South 363’ of the Southwest Quarter of the Southwest Quarter buildable for residential and
non-residential purposes. It was noted that the variance as approved is consistent with past actions of the Board of Adjustment.
Chairman/Otter Tail Count
Permit(s) required from Land & Resource Management
y Yes (Contact Land & Resource Management)
No
L R Official/Date
Copy of Application Mailed to Applicant, Co. Assessor and the MN DNR
bk 0407-001
329,512 - Victor Lundeen Company, Fergus Falls, Minnesota
August 5,'2010
Page # 2
Daniel D. Peterson - Approved the variance application as requested. (6:50 p.m.)
Daniel D. Peterson, part of the Southwest Quarter of the Southwest Quarter, Section 1 of Perham Township by
Roman Lake requested a variance to have the East 300’ of the West 805' of the South 363’ of the Southwest Quarter
of the Southwest Quarter declared buildable for residential and non-residential use. The audience was polled with no
one speaking for or against the variance as requested. After consideration and discussion, Michael Harris made a
motion, seconded by Joe Maske and unanimously carried, to declare the East 300’ of the West 805’ of the South 363’
of the Southwest Quarter of the Southwest Quarter buildable for residential and non-residential purposes. It was
noted that the variance as approved is consistent with past actions of the Board of Adjustment.
Eric and Jolene Larsen - Approved the variance application as requested. (6:52 p.m.)
Eric and Jolene Larsen, West Half of Reserve Lot C Coney Island Acres, West Battle Lake in Girard Township,
requested the following: We are requesting a 10’ setback from road right-of-way to build a garage. We will not enter
garage from 10’ setback side (south). We would enter garage from west side. The required setback from road right-
of-way is 20’. We will be adding a 5’ by 24’ section to the existing concrete slab which will allow the side lot line
setback to be 10’ instead of 5’. We would like to keep the existing slab, but the 24’ by 24’ structure to be built will be
10’ from the road right-of-way. Existing slab is 5’ from road right-of-way. The audience was polled with no one
speaking for or against the variance as requested. After consideration and discussion, Thomas Lee made a motion,
second by Joe Maske and unanimously carried to approve the variance as requested in the application dated July 8,
2010 and as depicted on the July 9, 2010 drawing submitted with the variance application.
Lakeside on Lida - Approved the variance application as modified. (6:58 p.m.)
Lakeside on Lida, part of Government Lots 4 and 5, Section 17 of Lida Township by Lake Lida, requested the
following: To build a structure 30’ by 18’ in place of existing 24’ by 18’ shed and 12’ by 6’ bath house. The bath
house will be removed. The existing 12’ by 6’ building is currently on the lot line (O’ setback). The proposed structure
(30’ by 18’) to be placed in same location as the 18’ by 24’ shed which is approximately 4’ from lot line on north side,
50’ from lot line on west side, approximately 30’ from marina on south side and 160’ from lake on east side. The
audience was polled with no one speaking for or against the variance as requested. After consideration and
discussion, Randall Mann made a motion, seconded by Steve Schiererto approve a variance of 10’ from the north
property line for the project as described in the variance application. After additional discussion this motion was
withdrawn. After additional consideration and discussion, Randall Mann made a motion, seconded by Steve Schierer
and unanimously carried, to approve the construction of a 30’ by 18’ structure at least 10’ from the north property line,
at least 10’ from the west property line, at least 75’ from the ordinary high water level of the lake and at least 30’ from
the marina. It should be noted that the variance as approve does not directly or indirectly grant any other variances
for the proposed development.
Wayne Burmeister- Approve the variance application as requested. (7:18 p.m.)
Wayne Burmeister, Lot 4 Block 1 Clitherall Original Plat, Clitherall City in Nidaros Township, requested a variance of
10’ from the required side lot line setback of 10’ for the placement of a septic tank 0’ from the side lot line. The
audience was polled with no one speaking for or against the variance as requested. After consideration and
discussion, Michael Harris made a motion, seconded by Joe Maske and carried with Thomas Lee abstaining, to
approve a variance of 10’ from the required side lot line setback of 10’ for the placement of a septic tank 0’ from the
side lot line. It was noted that the proposed system has been designed by a licensed installer and there is no other
location available for the placement of the septic tanks.
984218I
OFRCE OF COUNTY RECORDER
OTTER TAIL MINNESOTA
ih'sT„^r^:9842^
was filed/recorded lathis office for reiiprd Of) the—iS_day of ^
.2005 atUUQam/m^
teUntyJtecoFder
No delinquent taxes and transfer entered; Certificate of
Real Estate Vaiue ( filed (
Certificate of Reai Estate Value No.bywe'r-
(v»»)WendaLM
hyt K WAKi<^7Koe
Wayne Stein, County Auditor g$p«ty1
Pfir recordingjm well certit^teby
5-M WARRANTY DEED
Iiulividual(s) to Individual
STATE DEED TAX DUE HEREON: $ 275,55
Date: September 15,2005 Parcel #51.000.01.004.009
FOR VALUABLE CONSIDERATIONJ)Ai3ftL. PERUNGER AND BRENDA PERUNGER, huiband and wife,
Grantor(s), hereby convey(s) and warrant(s) to DANIEL D. PETERSON, Grantees, teal property in Otter Tail County,
Minnesota, described as follows:
See attachment for legal description.
together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions:
Covenants, Easements and Restrictions of Record, if any.
Check Box if Applicable:Q The Seller certifies that the seller does not know of any wells on the described real property,
n A well disclosure certificate accompanies this document.
I am familiar with the property described in this instrument and 1 certify that the status and nuriiber of wells on the
described real property have not changed since the last previously filed well disclosure certificate.
COUNTY OF OTTER TAIL
STATE OF MINNESOTA
DEED TAX $NUMB
DATE
David L. Perlinger
HnjutAAfiju PMvyux^
Brenda Perlinger w
STATE OF MINNESOTA )
)ss.
COUNTY OF OTTER TAIL )
The foregoing instrument was acknowledged before me on this 15th day of September, 2005, by David L. Perlinger and Brenda
Perlinger, husband and wife, Grantor(s). /
NOTAKIAL STAMP OR SEAL (OR OTHERTITLE OR RANK)
[g"nat1 PERSON TAKING ACKNOWLEDGEMEhTTJODIL.SAZAMA |
Check here if part or all of the land is Registered (Tofrens) Q
Tax Statements for the real property described in this instrument should be s«u to
(include name and address of Grantee):
THIS INSTRUMENT WAS DRAFTEO BY (NAME AND ADDRESS)
Daniel D. PetersonTitle Services of Perham
160 3rd Ave. S.W. PO Box 187
Perham, MN 56573
Order No.: 18622
Fb 6oy 3SS0
SCANNED
(
»‘1
*
k.
All that part of the Southwest Quarter of the Southwest Quarter of Section 1, Township 136,
Range 39, described as follows: Commencing at the southwest comer of said Section 1;
thence on an assumed bearing of South 89 degrees 18 minutes 49 seconds East, along
the south line of said Section 1 a distance of 505.03 feet to the point of beginning of parcel
to be described; thence North 00 degrees 12 minutes 51 seconds East a distance of
363.00 feet; thence South 89 degrees 18 minutes 49 seconds East, parallel with the south
line of said Section 1, a distance of 300.00 feet; thence South 00 degrees 12 minutes 51
seconds West a distance of 363.00 feet to the south line of said Section 1; thence North
89 degrees 18 minutes 49 seconds West, along the south line of said Section 1 a distance
of 300.00 feet to the point of beginning. Contains 108,896 square feet of 2.50 acres, more
or less. Subject to roadways, restrictions and easements of record, if any.
1 n Ipioo 3
iiOAlMIMED
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Form No. 1' WARRANTY DEED.OOWALO CO» NKW UkH. MIHH._____
IklinDCOOta Uoiform Cooveyaoctas BUnk»Individuai to ladhridual
„ 7g"
.................r..............................> ...........•^5'oTlfis ^nlicnimr^,
Paul Gene LaFond and Bernice R. LaFond, his wife
day of.Made this.
hetiueen.__
Otter Tail Minnesotaand State of.of the County of
part..i:&3._of the first part, and.____Ry.tb.—iI ;I
!
Otter Tail Minnesotaof the County of.
part.y.........of the second part,
V/itnesseth, Thidollar and oth
and State of.
d part. X.^.S. of the first papt. in corpsideration of the
d and valuable consideration-'^jQ^^i^/js
;
at the sai
er goo
_iw. hand paid by the said part.y.
hereby Grant, Bargain, Sell, and Convey unto the said partY.
......her..........
ff *‘"^i ljC"f and beind in the County of.
scribed'la& follows, to-wit:
!--Onesum of..7.to......thein
acknowledged, do.
second part,...........
!i of the second part, the receipt whereof is hereby
of the
heirs a?id assigns. Forever, all the tract.... or parcel....
...............................and State of Minne^^Tf 1
' Ii
of
That part of the Southwest % of the Southwest \ of Section 1,
Township 136, Range 39, Otter Tail County, Minnesota, described
as follows:
J.g at the Southwest corner of said Section 1, thence on
c bearing of East on the Southerly line of said Section 1
for a distance of 505 feet to point of beginning of tract to be
described: thence North 0? 28' 50" West parallel to the Westerly
line of said Section 1^for a distance of 545 feet; thence on a
bearing of East parallel to the Southerly line of said Section 1 for
a distance of 200 feet; thence South 0 28' 50" East parallel to the
Westerly line of said Section 1 for a distance of 545 feet more or
less to the Southerly line thereof; thence on a bearing of West for
a distance of 200 feet'more or less on the Southerly line of Section
1 to point of beginning, containing 2.5 acres more or less, subject
to the rights of the public in county state and P^oute No, 8.
Commencin
an assume<<
1Angles taken from Certificate of Survey by Robert B. Oslund &
Associates, dated November 19, 1973.
Rr.w'Sji
y .. r. '
fitnpp ICI.
A PART OF THli,
•, ;
$2.20ate Deed Tax:\
To Have and to Hold the Same, Together with all the hereditaments and appurtenances
of the second part,..Jfk^Y.........thereunto belonging or in anywise appertaining, to the said part..y.
heirs and assigns. Forever, And the said._.P.auL..Gene..LaF.D.n.d .and..3.emlC.e...R.....L.aF.Q.nd.
his wife
j..................
of the first part, for .t.h.sms elves j . their executors and administrators, do.
with the said part...y......... of the second part,.....................her....................................heirs and assigns, that
t.h.ey._ are seized in fee of the lands and premises aforesaid, and hay.?... good right to sell and
convey the same in manner and form aforesaid, and that the same are free from all incumbrances,except those "of record or those incumbrances knov/n to purchaser.
covenant
■;
«*
And the above bargained and granted lands and premises, in the quiet and peaceable possession of the
said part..y..........of the second part.he.r heirs and assigns, against all
persons lawfully claiming or to claim the whole or any part thereof, subject to incumbrances, if
any, hereinbefore mentioned, the said part les of the first part will Warrant and Defend.
In Testimony Whereof, The said part...%.^?..
hand.?.the day and year first above written.
theirof the first part ha.y.?..hereunto set
PAUL'GENE'LAFONb....................................i
. liSTvrrEOF - .j^v;^. .DEPT.OF =
■ p." nnocniq y-. TAXATION =
-ora------i
n A,5‘P Aue2978
W ITAX BOOK-Sp/ PAGF/X5- RB. f!l23. — ---
____________• i
!BOOK^ PAGEa2A
#’tatc nf Minnesota,
Otter Tail S8,
County of.
Ui^78On this..................................................day of
o ..............................................................within and f&r said County, personally appeared
Paul Gene La Fond and Bernice R. LaFond, his wife
........, 19S~,.before me.
\to me known to be the person....S..described in and who executed the foregoing instrument,
.........................................and acknowledged that X-...he..Y executedI!the same as....their._free act and deed.I
AI
< .............................................................................‘f-ftttttttti: TWYLA J. SUOMALA
^ WOTABr PUBLIC • MINNESOTA
OTTER TAtL COUNTY :
Mjr Comniulon Capirai Sept 9, 1983 i
...............................................
Notary Public.^.County, Minn.
\i
:My commission expires.-.19____
I
i
i
^tate of JHinnesota,
Otter Tail ss.
County of.
On this......., before me,
within and for said County, personally appeared
day of.19.
a.
1 to me known to be the person.described in and who executed the foregoing instrument,
..........................................and acknowledged that ....he.... executed }the same a.sv free act and deed.
)
t
J^otary Public County, Minn.
^dy commission expires . 19
THIS INSTRUMENT WAS DRAFTED BY
;Dennis W.Happel(Name)
225 West Main r
Perham^ 56573(Address)
Tax Statements should be sent to:f i
Ruth Derke
RR 1
Perham, MN 56573i
J
PTing requirarnsnis fnr 4 j
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MiUer-Daris Cc., MinttiASG.is
Minnesota Uniform Cor.veyaudas BlanksWarran*y Deed
Individusl to Joint Tenants Foma No. 5-M
i
Snbenture, Madetnu..................
Korr^an I. ..'.e.yev ard rhylli? i-.i.i;yer
18th , 19. ?y. ,..........................._anl nrth'jr Terhu'- ar.lday of.............
, niFbetiveen.
i.-'/elyr, 'Iernu<=, hi?
I
;.’inrie'-otaOtter Tt:l 1 ■j ,of the County of.........
of the first part, and
..............and SI- of , pari
................, of the County of
parties of the second pari.ilihiiepota........0.t.t.er..'4;£.il.and State of.iI
1I :lepThat the said part
Three „
of the first part, in consideration of the- sum of ...I
i-..-..DOLLARS,i
!..then., in hand paid by the said parties of the second part, the receipt "whereof is hereby achnuU’l-
hereby Grant, BaiAain, Sell, and Convey unto the said parties of the second part as joint
to
edfad, do
tenants and not as tenants in coinmcn, their assigns, the survivor of said parties, ami the heirs end
assigns of the survivor. Forever, all the tract....or parcel..... of land lying and being in the County of
....................................................... and. State of Minnesota, described as follows, to-wit;
!
The South 700 feet of the nert 1205 feet of the Eouthwert quarter o'' the Scutixert
quarter (S.Vj of SVi:-) of Seeticr. one (1), Tov.nrhip one hundred thirty-air. (13o), hanre
thirty-nine (59) subject to public road'=^ thereon ant eaaerT;fcnt= therefor.
>(
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;
;I
I Drl: Tax
S'-**DEED TAX
JUNIi «/
!• ' ^3.30
I
;i 1
tito jl^abC atlb to li^olb Gallic, Together with all the hereditaments and appurtenances there
unto belonging or in anywise appertaining, to the said parties of the second part, their assigns, the sur
vivor of said parties, and the heirs arid assigns of the survivor. Forever, the said parties of the second part
taking as joint tenants and not as tenants in common.
And the said.....iS'o.m;&n...T......ii.cye.r.,.Enu....hhy.lLi5....n.....ilt..yer..,.,.l.i.s....v;.if,.e ....and......................................
•-"■rthur dernur end xrelyn Ternur ^ hi .<=
of the first part, /or i^.h.s.hhh-r-.y®?..*., tr-.?.ih.
covenant -with the said parties of the second part, their assigns, the survivor of said, parties, and the heirs
and assigissof the survivor, that....'^‘^v}'....^T..^......well seised in fee of the lands and prernises aforesaid and
ha y.® good right to sell and convey the same in manner and form aforesaid, ami treat the same
free from all incum'ornnees, i
1
I
I
!i ies heirs, executors and administrators dopart "
;i !
arc
!And ilic above bargained and granted Lands and premises, in the quiet and peaceable, jrossession of the
said parties of the second part, their assigns, the survivor of said parties, and the iicirs and assigns of the
survivor, against all persons loirfulhj claiming or to claim the whole or any part thereof, subject to
uieinnhrances, if any, hereinbefore mentioned, thw said part .\F~. of the first part will Warwajif and
Deed tax hereon due v6.ecDefend.
3!n ^CcSf^mor^p JSfjcrcDf,
hand - the, day ami year first above written.
The said part...i.'"’ of the first part ha T.S... hcre,vnto set t.h.e.i.i;.........
;
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BOOKi^ PAGE„:L.
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m.Am®.a o0OFFICE OF REGISTER OF DEEDS
fiftate^ot itlimietfota.
/ hcrchy certify thcib. the within Deed
was filed in thw o/Jli^ nr record on the
Jpr.-.P>.^.day of..............................................,
tt/ffP-Pt., at..//.t.t^..£P!...o‘cloeh ...ePP^.... M.,
ami was duly recorded in Book..ff J,.^....
of Deeds, pade...........................
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Taxes paid and Transfer entered this
<^f?-Ppp.k\.day of...............................................,
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3■Vf/rr^i'-rrrrrr:'...................................
County Aiulitor
.................., Deputy
Tax slat' iiK’nts for the real properly
described in this inslnnncnt shoiiltl be
sent 1(1 :
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/Quit ClalA Dead (individual to Joint T Ott.ue o' i.i li Ty Rjicordei ^
Cc '?v 0? CV.'f TaS
I Mfrty ccrrrv
for recofO m :n .• .• i,o tfw day of'' ^____ii/0:^Av
IS duly ft^v.:'>-iv; as Docy^*^
" County Racordar
QUIT CLAIM DEED
«asfiMNo delinquent taxes and transfer
entered; Certificate of Real Estate
Value ( } filed not required ancr was
Certificate of Real Estate
Value No Jl4 ... ..Oeouty
VoaW^County Auditor
By
/Deputy
STATE DEED TAX DUE HEREON: $1.65
Date: \t> ^
FOR VALUABLE CONSIDERATIONTRuth Derke, a jingle person, Grantor,
hereby conveys and quitclaiBia-_to Williagrijerke and Bernice LaFond,
Grantees, as joint tenanusT—^eat^property in Otter Tail County,
Minnesota, described as follows:
That part of the Southwest Quarter of the Southwest Quarter of
Section 1, Township 136, Range 39, Otter Tail County,
Minnesota, described as follows:
Commencing at the Southwest corner of said Sectioj. 1; thence
on an assumed bearing of East on the Southerly line of said Section 1 for a distance of 505 feet to point of beginning of
tract to be described; thence North 0*’28'50'’ Hesc parallel to
the Westerly line of said Section 1 for a distance of 545
feet; thence on a bearing of East parallel to the Southerly
line of said Section 1 for a distance of 200 feet; thence
South 0^28'50” East parallel to the Westerly line of said
Section 1 for a distance of 545 feet more or less to the
Southerly line thereof; thence on a bearing of West for a
distance of 200 feet more or less on the Southerly line of
Section 1 to point of beginning, containing 2.5 acres more or
less, subject to the rights of the public in county state and
Route No. 8
r r
'■ *”1
together with all hereditaments and appurtenances belonging
thereto.
The total consideration for this transfer of property is $500.00 or
less.
. I
-Ruth Oerke SCANNED
)STATE OF MINNESOTA
) as)COUNTY OF OTTERTAIL
The foregoing instrument was acknowledged before me this
day of 1996, by Ruth Derke, ^^l^gle person^ Grantor.
'V TERfiYAKAHKEU
NOMRYPUBUC-MiM^CSOn i«\
onaniL COUNTYMrOoHMiEmifM 01^-00
;
m I n'Stary public1^'eewpsw-i'.
Tax Statements for the real property described in this instrument
should be sent to:
Ruth E. Derke
RR 1 Box 46
Perham MN 56573
THIS INSTRUMENT WAS DR/FTED BY:
IRVINE, RAMSTAD, BRIGGS,
KARKELA & ZIEGLER, P.A,
450 West Main
P.O. Box 419
Perham, Minnesota 56573
(TAK/tm)
SCANNED
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
WHITE - Office
GOLDENROD - Inspector
YELLOW - Owner (after Issue)
PINK - Assessor
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
'sectionLAKE / RIVER NOJ/IaKE/RIVER NAME
RomcLin
TWP NAMERANGETWP NO,LAKE/RIVE^
CLASS
31N£Of )i0
PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)
5~/ OOP 6/ 0)00^ 06^
LEGAL DESCRIPTION
^ }oo^ V/ 5 ytT y<t Jf. 5~0
Daytime Phone No.Initial Mailing AddressFirstLast Name
AAtmC. I P "
/-4Al S(o 57^
Property
Owner j/
Contractor
Name
Lie.#
ONSITE WATER SUPPLY
Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM
(^ Permit No. ^ ^
( ) OTWMD 'Must have Sewage System Approval
from OTWMD prior to issuing Sile Permit.
Contact Rollie Mann at 218-864-5533
PROPOSED PROJECT (please circle the appropriate number)
(1 ) New Dwelling (^Add'n to Dwelling;/'^ (^
(4) MH/YR____
(7 ) Add'n To Non-Dwelling (8 ) Storage Structure
(10) Non-Conf, Replacement (identify)___________
(11) Other (identify)________________________
‘Existing Dwelling to be removed prior to__________
( 3 ) ‘Replacement Dwelling
i6>^achedArf^ched Garage
(9 j W.O.A.S.
(5) RCU/Year.
1 CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension
HARACTERISTICS OF PROPOSED DWELLING
lust Include Attached garage)/b Outside
DimensionFt. XFt.“Outside Dimension
Sq. Ft.
Setback to Lotline
Ft.yFt. X
XSq. Ft.
Setback to Lotline
Setback to Right of Way\_______
Setback to Ordinary High W^r 1^1
Elevation Above Ordinary Hig])rV^ter Level
Setback to Septic Tank /
Setback to Drainfield /
Setback to Bluff X
Maximum Prpdosed Height
Roof Chartge ( ) Yes ( ) No
Bathreom Proposed ( ) Yes ( ) No
Sq. Ft. X
Setback to LotlineX
Setback to Right of Wa
Setback to Ordinary High Vt^t^evel __
Elevation Above Ordinary Hjrfrmaler Level
Setback to Septic Tank /
Setback to DraintielX
Setback to Bluff/______
Maximum Praposed Height
( ) BoatJjouse
( ) Gazebo
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
\Ft.”Ft.&Ft.&
Setback to Right of WayF^‘ . *
Setback to Ordinary High Water Levej^ yOjk^A Ft.
Ft.&Ft."
Ft,"
Ft.___Ft.Elevation Above Ordinary High Water Level
Setback to Septic Tank j^O Ft.
Setback to Drainfield Ft.
Setback to Bluff___
Total Bedrooms 3
Maximum Proposed Height
Roof Change ( ) Yes (^ No
Basement (^ Yes ( ) No
Walkout Basement ( ) Yes (sideprolile required) No
Ft.
Ft.
Lt-VA Ft.Ft.Ft.
Ft./i_Ft,FI.
Ft.Ft.
( ) Screen Porch
( ) Storage Structure
^ A-p=ip>\.* Must include on scale drawing,
additional Permit may be required.
Topographical Alteration / Earthmovina
□ None 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More*□ 20 Cubic Yards or Less *
CHARACTERISTICS OF LOT;
AJf)r Bluff ( )Yes (^No
io0(-3r'
Ft.Water FrontageLot Area.
Total Lot Area (FT^)Impervious Surface Ratio;X 100 =.%T
Impervious Surface RatioTotal Impen/ious Surface Onsite (FT')
THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. 1 further agree that any plans and specifications submitted herewith shall become
a part of this permit application. 1 also understand that this permit is valid for a period of six (6) months.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my responsibility to inform the Land & ResptiTJee Manaoement officejiDce the building footings have been constructed.
ilA/hSDate:
\Propi leT/Agent for Ownertignati
Date:
Land & Resource Management Office
PROJECT(S)TOTAL SQ.FT.PERMIT FEE $RECEIPT NO.
Comments:
SCANNED
Form No. BK — 1003^0407 329.582 • Victor Lundeen Co.. Printers • Fergus Falls. Minnesota
APPLICATION FOR GRADE & FILL PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
RANGE TWP NAMETWP. NO.SECTIONLAKE/RIVERLAKE/RIVER NAMELAKE/RIVER #
61/}^01
PROPERTY (E-911) ADDRESSPARCEL NUMBER(S)
<?] nOD m M
LEGAL DESCRIPTION
DAYTIME Phone No.Mailing AddressInitialFirstLast Name
imJ2Property
Owner
Contractor
Name
Lie.#
NOTES: 1. The lotlines and project area(s) must be staked.
2. If project disturbs more than 1 acre of land you are required to obtain a General
Storm Water Permit from the MPCA.
Received
DATE
PROJECT REQUEST (You may use the grid on back for required scale drawing);
IKAJI (A^\j<SArks.jr lu.se lU'DESCRIBE YOUR PROJECT(S):
A\A Vi) \m /
DETAILED INFORMATION:
AREA TO BE CUT/EXCAVATED:Ik ±1£Yds^Ft. X Ft. X Ft. - 27 =Length Ave. Depth
Yds®WALK-OUT BASEMENT PROJECTS:
(Outside of the building foundation)
Ft. X Ft. X Ft. f 27 =
Length Width Ave. Depth
Yds®AREA TO BE FILLED/LEVELED:Ft. X Ft. X Ft. -27 =
Length Width Ave. Depth
Yds®TOTAL EARTHMOVING REQUESTED =
L Ft.
MaxTOepth UlBACKFILL AT FOUNDATION;Ft.
Distance From Foundation
CULVERT:If Yes, must indicate size and location on drawing.
Yes No
IMPERVIOUS SURFACE:%
^CANNED
...^IGNATUFtrb^F^ROPERTY OWNER/AGENT FOR OWNER
BK02/09
RECEIPT NUMBER
I
SCALE DRAWING FORM
5/ d\ r)o9
Tax Parcel Number(s)
T
The scale drawing must include the outside dimension (lotlines) of the property above the ordinary high water level, and must identify the type,
size (square feet), and location of all existing and proposed structures, additional onsite impervious surfaces, road right-of-way(s), ordinary high
water level(s), septic tank(s), drainfield(s), bluff(s) & wetland(s). Must also include all proposed topographical alterations.
'r
%Scale Impervious Surface Ratio
(Must Complete Worksheet On Other Side)
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Signature of Property O^er Date 'r'-r-f—t—
* Victc| Lundsen Co. Priniws * Fergus ^alls. MN i_ l>ec^34&40^
iBK — 0207 329.086-T-i i II !
IMPERVIOUS SURFACE CALCULATION WORKSHEET:
List of Onsite {Existing and Proposed) Impervious Surfaces (must be shown on scale drawing):
^oo\Ft2Structure(s):
Ft2Deck(s):
\4ob Ft2Driveway(s):
Ft2Patio(s):
Ft2Sidewalk(s):
Ft2Stairway(s):
Ft2Retaining Wall(s):
Ft2Landscaping:
(Plastic Barrier)
Other:Ft2
Ft2TOTAL IMPERVIOUS SURFACE:
Ft2LOT AREA:
. ltA‘^60 ,6UT
TOTAL IMPERVIOI
.%X100 =
IMPERVIOUS SURFACE RATIOUS SURFACE LOT AREA
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