HomeMy WebLinkAbout53000990762000_Conditional Use Permits_04-15-1992Conditional Use Permits
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OTTER TAIL COUNTY
Conditional Use Permit CUP^5o^^
OWNER'S NAME: --------------------------------------------------------------
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NOTE; This card shall be placed in a conspicous place not more than 4 feet above grade on the premises on which wc
to be done, and shall be maintained there until completion of such work. NOTIFY DEPARTMENT OF LAND AND RESQU
MANAGEMENT, TELWH^E (218) 739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED.
jL^ otter tail COUMTY, minnesc
/t***^*"^_________________ Board of County Commi^QiQnera
^ fand and Resource Management Official
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1. Earthmoving shall be done between /4yru I ^
2. Entire area shall be stabilized within 10 days or the completion of any earthmoving.
3. Owner is legally responsible for all surface water drainage that may occur.
4. No fill shall enter or be taken from the beds of a public water without a valid permit from the State of
Minnesota Department of Natural Resources.
5. If the terms of this permit are violated the entire permit may be revoked and the owner may be subject
to legal prosecution.
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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
1.
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
TWPNAMESECTIONTWP. NO.RANGELAKE/RIVER
CLASSLAKE/RIVER NAMELAKE/RIVER #
OOP ^90 9 (oJLaoo
PROPERTY (E-911) ADDRESSPARCEL NUMBER(S)
LEGAL DESCRIPTION
I Cast Name / "S \ Firsi
■ / T^IocJt. /
^HlnaAddress • ---=^==^= ^ DAYTIME Phone No.Nlnitial
y99-7V/9/3~ ^IProperty
Owner
<S3^y?
Contractor
Name
Z^ZLie.#
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NOTES: 1. The lotlines and project area(s) musTbe stalfedy' y2. If project disturbs more than 1 acre oflan(fyou^^ repiuin
Storm Water Permit from the MPCA. n.
obtain a Generai
Received
DATELSR Official
PROJECT REQUEST (You may use the grid on back for required scale drawing):
'n/V\eK^O -
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DESCRIBE YOUR PROJECT(S):
A J-It VP
J)li Cir\—----jnl^C
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DETAILED INFORMATION:
AREA TO BE CUT/EXCAVATED:ft X 5?/ A Yds®ftr + 27 =Ft. X
Width Ave. DepthLength
Yds®Ft. +27 =WALK-OUT BASEMENT PROJECTS:
(Outside of the building foundation)
Ft. X Ft. X
Ave. DepthLength Width
Yds®Ft. X Ft. +27 =Ft. XAREA TO BE FILLED/LEVELED:Width Ave. DepthLength
Yds®TOTAL EARTHMOVING REQUESTED =
Ft.BACKFILL AT FOUNDATION:Ft.
Distance From FoundationMax. Depth
CULVERT:If Yes, must indicate size and location on drawing.
Yes No
IMPERVIOUS SURFACE:%
RECEIPT NUMBERDATESIGNATURE OF PROPERTY OWNER/AGENT FOR OWNER
BK02/09
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