The URL can be used to link to this page

Home My WebLink About14000990425000_Variances_05-15-19725-15- m2.White — Office Yellow — Owner Pink — Township APPLICATION FOR VARIANCE FROM Requirements of Shoreland Management Ordinances Otter Tail County, Minnesota Phone NoOwner; Last Name First Middle M State Zip No.CityStreet & No. rA- ? 8- 3Legal Description; Lake No.. Sec. Lake Name Lake Class fy^j)lATwp. I ^Range Twp. Name. If applicant is a comoration, what state incorporated in____ Applicant is; (i>)^wner ( ) 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. Jioreland Management Ordinance, Otter Tail County, Minnesota for conditonsfound inThis application for deviation is froi Iwhat Section of the Ordinance; EXPLAIN YOUR PROBLEM HERE: <.X\'S In order to properly evaluate the situation, please provide as much supplementary information as possible, such as; maps, plans, information about surrounding property, etc. 19.. XApplication dated Signature of-AppMcant —DO NOT USE SPACE BELOW— 19___Date application filed with Shoreland Management Administration. Planning Commmission approva+^<^ Shoreland Management approval only,,f'^^Both ( )Deviation requires; ByFiling acknowledgement Signature Date, time and place of hearing DEVIATION APPROVED this______ (OR A TTACHED) REOUIREMENTS: 19____WITH THE FOLLOWINGday of_ Signature. Frank Alstadt. President Otter Tail Planning Advisory Commission Deviation Approved this ___________MficWm K. Lee, Shoreland Management Administrator Otter Tall County, Minnesota day of.•■y1• By. MKL-0871-016 vicro* LUHOCtN k <0 MiHTCkk. rcksvs rkLLk «••••• 150079 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM White - Office Yellow — Inspector Pink — 0\yner Card — Owner Permit No.,LEGAL Date DESCRIPTION AND LOCATION Lake No. Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only 19 M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD Sq. Ft.Capacity GIs.Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. Distance from occupied building Ft.Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft. Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on ,, 19 , Time JVI By PERCOLATION TEST DATA:Date of First Test ,, 19 , Rate Date of Second Test 19 , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Dated Signature Permit: condition that the person to whom it is granted, and his agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE; Permit void if work is not commenced within six (6) months. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express Issued Date: Shoreland Management Office Fee $Surcharge $ Comments:. Form No. MKL-0771-003 viCToa kuascEN 4 c».. rEM«us rakL*. ma. 158906 m INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORYActualShould be Actual Should be Actual Should be Capacity GIs.GIs.S F S F S F S F Distance from Nearest Well F 75FF F 50F F Distance from Lake or Stream F F F F F F Distance from Occupied Building 10 20 20FFFFF F Distance from Property Line 10 10F 10FFFF F Distance from Bottom to Water Table 4 4FFFFF F Inspector's Comments: 1 Date of Inspection 19___ Time of Inspection M ■ii- Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF ” Square Feet F “ Linear Feet Job Title AgencyMKL-0771-003-Backer V r a'"'■| • —'