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Home My WebLink AboutAllstopp_36000190138000_Shoreland Permits_Offfte Owner White Yellow Pink — Assessor , Goldenrod ~ Inspector SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT , Permit No..LEGAL DESCRIPTION I-JlaJ'v-l.AND LOCATION nM-w TWP Name 5ijr \Ub Lake Name '31 ^T-O TWP RangeSec.Lake Classif.Lake No. IDENTIFICATION: Please Print All Information Tel. No.Zip No.Mailing Address- No. Street. City and StateFirstInitialLast Name >or\e^W -s:c\ (U._________ ___________________yVs'V^ AilS'VopP ThonviK^Owner £S32,i NameContractor Architect Name, NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT: One Family Dwelling ( ) Multiple Dwelling Specify:,New Building ( ) Alteration Units I Size( ) Other ( ) Other ESTIMATED COST OF IMPROVEMENT $ DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME: ( ) Masonry ._Jj ) Wood Frame ( ) Structural Steel ( ) Other — Specify Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms ( ) Public Individual Septic Tank, etc. " WATER SUPPLY: Baths( ) Public ) Individual Well Type of Roof: CHARACTERISTICS: .^...^^^rj?:^-Tj?r^quare feet.feet.Maximum depth of lotWater frontage is feet.Lot Area is feet. (Building Line)Building set back from high water mark is. Land height above high water mark at building line is Building set back from State highway right of way..... feet ,!A.O.,S2;o feet — from road right of way is feet. .i.D.,\.0.feet.Side yard is and \ ^.feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.). Structure will be located ’ZJOStructure will be located 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. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of sbc^)^m^nths. THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA ST A TE ST A TUTES./ Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the express condition 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. Permit: \Q 'XO xo Dated Shoreland Management OfficialiLR-Permit Fee $. \V VO xV\Comments: i195676(vp VICTOR LU.NOCEN CO.. PRINTERS. FERGUS FALLS. MINN.Form No. MKL-0771-002 ’’ tSHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 - Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT Whije — Office Yellow — Owner Pirf* — AMe^or Goldenrod i- Inspector 1« r . r V> u Permit No„iLEGAL DESCRIPTION I' M .i ' j 'AND I LOCATION TWP NameTWPRangeLake Classif.Sec.Lake No.Lake Name IDENTIFICATION: Please Print All Information Zip No.Tel. No.Mailing Address— No. Street. City and StateLast Name First Initial Owner NameContractor 4ArchitectName, 4 TYPE OF IMPROVEMENT:NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE: ( ) New Building ( ) Alteration ( ) One Family Dwelling ( ) Multiple Dwelling ( ) Other Specify:. Units I ( ) Other Size 1ESTIMATED COST OF IMPROVEMENT $ PRINCIPAL TYPE OF FRAME:»TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry ( ) Wood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: I ) Public ( ) Individual Well Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms Baths Type of Roof:! , CHARACTERISTICS: feet.square feet. Water frontage is Maximum depth of lotLot Area is feet.1 Building set back from high water mark is.................... Land height above high water mark at building line is Building set back from State highway right of way..... Side yard is ..................... Structure will be located feet. (Building Line) feet feet — from road right of way is feet. feet.and ■feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.).Structure will be located 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. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. ;THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16. MINNESOTA STATE STATUTES.Signature of Owner Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit: express condition 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. Dated Shoreland Management Official Permit Fee $. Comments: r 195676® VICTOR UmoEEN CO.. PRINTERS. FERGUS FALLS. MINN.Form No. MKL‘0771-002 t, I •> •» INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL MINIMUM Shall Be 4-IS 1 Sq, Ft. Sq. Ft. QpO Lot Area (Square feet)Sq. Ft. Water Frontage Ft.Ft. t/s>F,.Building Set Back from High Water Mark Ft. »-Building Set Back from State Highway Ft.50 Ft. TjTTBuilding Set Back from Street or Road Ft.40 Ft. Ft.& /^ Ft.Side Yard <i^r HoRear Yard Ft.Ft.4 Occupied Building to Septic Tank Ft.10 Ft. Occupied Building to Absorption System Ft.20 Ft. Elevation at Building Line above High Water Mark_____________Ft.3____ Inspector's Comments: - <3a.XXZL^ i j\h^_ - Inspector's Signature Title Inspection Dated 19 Agency1 VICTOH UMMCIi * M-. rCMW* FJILLa. KIN*. t > % A - zo - ey/ ! (^f3^ QQIlaJCcjipI ! I 4! ii-_t ti * * \ : --v-y ,-$L«A ->f9 -^r’