HomeMy WebLinkAboutBig Pine Lodge_8041306_Shoreland Permits_Land & Resource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
Land & Resource Management
Government Services Center
540 Fir Avenue West
Fergus Falls MN 56537
Phone: 218-998-8095OTTCn TAIIoovatv-niei(IOTA
Site and Lot Alteration Permit (combined)
Permit #____
Applicant Information
Applicant Infbnnation:Name:
Joe Hallow
I Phone:
11(218 )??8 - 2358
Email Address:
joehariow43606@gmail.com
Mailing Addres
43606 Mosquito Hts. Rd.
Pertiam Mn 56573
I am the:Property Owner
Work Performed Bv (Site Permit)
Work to be pertOrmed by
(Site Permit):
Self
Work Performed Bv (Lot Alteration Permit)
Worit to be performed by
(Lot Alteration):
Property Information
Property
Please
search by
one of the
following:
Paicel #.
name, or Physical
Address.
Click the blue
“Select" to select
Selected:
Property Attributes Property Address Legal Description Primary Name/Address
Parcel #Property Address Legal DescriptionCity Legal Description Legal Description Primary Address Line 1 CityName
52000170112006 43606 MOSQUITO
HEIGHTS RD
PT GL 1 COM
W1/4 COR SEC
DEG E 20' S 36
DEG E 316.35'
43606 MOSQurro
HEIGHTS RD
PERHAM 181.5'N 44 DEG E
350'S 45
JOSEPH
& LISA
HARLOW
PERHAM
17 N
Lot Area:219123 Square Feet
Is the
property
Developed or
Undeveloped?
On Site L&R Cert, of Compliance within 5yrs.
Sewage
Treatment
System:
Onsite Water Indiudual Supply:
Developed
(A
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Land & Resource Permit Applications https://onegov.co.ottertaiI.mn.us/view.php?id=5289&viewOnly= 1 ...
t
Shoreland Information
i!Associated Lakes:Selected;
Lake Name ONRID Lake Class LRCD
GDBig Pine 130 56-130
Water Frontage:<310 Feet
Bluff:No
Proposed Project (Site)
Proposed Dwelling:Addition to Dwelling
Is there an Attached Garage? No
Proposed Non-Dwelling:
Proposed Water Oriented Accessory Structure: |
Please list outside dirnensions (in 2116 sq. ft deck, 984 sq. ft.
feet) ||
of above items you are'applying
^ck(s)
None
Lean to storage.
for li
Characteristics 'of Proposed Dwelling
New or Replacement: |New
Square Feet:
Maximum Proposed Height:
Setback to Lot Lines
Ondicate closest lot lines):
^ Square Feet
25 Feet
M Feet!
i'ZOOFeet
50 Feet
,175 Feet
Setback to Right of Way:<1Setback to Ordinary High Water
Level: |
Setback to Septic Tank:Setback to Drainlield: I 10 Feet
K Feet
Na Feet
16 Feet
;i
Setback to Bluff: i
Elevation above Ordina^ High
Water Level: '
Total Bedrooms:::0
•1
Roof Change:No.1
Characteristics of Proposed Deck
2116 Square FeetSquare Feet:
Maximum Proposed Height:
Deck Stbck Lot Line 1 |
(indicate closest lot tines):
\11 Feet
50 Feet
I 1^0200 Feet
50 FeetISetback to Right of Way:
Setback to Ordinary High Water 175 Feet
Level: '
Elevation above Ordinary High
Water Level: j
Setback to Septic Tank:
Setback to Drainfield: ■
)
16 Feet
10 Feet
100 Feet
Na FeetSetback to Bluff:
Proposed Project YLot Alteratloni
Add lakeside elevated deck with entrance/exit accessibility ramp, and lean to addition to
second level for storage (walk in coolers, dry storage).
Project Type:Project Description:Impeiyipus1Surface
Foundation Type:Post
Construction
Culvert and Road Authority
I.Culvert?No
Road Authority Approval^N?
i
:1A
2/5/2019, 8:43 AM2 of 5 *
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.Land & kpsource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
;8
Impervious Surface - Buildinas}(
Dwelling Existing:2860 Square Feet
0 Square Feet
p Square Feet
Dwelling Proposed:
Attached Garage Proposed:
Detached Garage Proposed:
Storage Shed Proposed:
Water Oriented Accessory
Structure Proposed:
Recreational Camping Unit
Proposed;
Miscellaneous Proposed:
Total Building Proposed Impervous:
3100 Square Feet
p Square Feet
p Square Feet
p Square Feet
0 Square Feet
Attached Garage Existing:
Detached Garage Existing:
Storage Shed Existing:
Water Oriented Acce
Structure Existing;
Recreational Camping Unit Existing: |iMiscellaneous Existingjj
Total Building Existing Impervious:
;i 2640 Square Feet
^ Square Feet
i;!l
ssory
13600 Square Feet 0 Square Feet
2128 Square Feet
2,1,^ Square Feet I
p Square Feet
3100 Square Feettons
Impervious Surface Calculation - Buildinas
Total Building Existing Imperaous: 21648 Square Feet
Total Building Proposed,|Impervious:
Total Building Imperious Surface: 24748 Square Feet right
Lot Area:
Impervious Surface Ratio:
Buildings Impervious Sui^ce
Percentage: i
3100 Square Feet
.1
219123 Square Feet|i
0.1129
11.;.?.?%
mpervious Surface - Other
Deck(s) Existing:
Patio(s) Existing:
Sidewalk(s) Existing: ’
Landing(s) Existing: |
Drlveway(s) Existing: ^
Parking Area(s) Existing:
Retaining Wall(s) Existing:li
Landscaping Existing:
0 Square Feet
0 Square Feet
p Square Feet
p Square Feet
p Square Feet
p Square Feet
p Square Feet
0 Square Feet
p Square Feet
p Square Feet
6800 Square Feet
0 Square Feet
^0 Square Feet
200 Square Feet
156% Square Feet
5213 Square Feet
0 Square Feet
0 Square Feet
p Square Feet
Deck(s) Proposed;
Patio(s) Proposed:
Sidewalk(s) Proposed:
1
Landing(s) Proposed:
Drlveway(s) Proposed:
Parking Area(s) Proposed:
Retaining Wall(s) Proposed:
Landscaping Proposed:
Miscellaneous Proposed;
!i
Miscellaneous Existing; ;j
Other Existing Total:Other Proposed Total;27999 Square Feet,1
Impervious Surface Calculation - Buildings & Other
Total Building Other Existing 49647 Square Feet Impervious:
Total Building ->* Other Proposed 3100 Square Feet Impervious:
f.
iTotal Building + Other Impervious 52747 Square Feet
Sur^ce:
Lot Area:
Building + other Imperious
Surface Ratio: ij
Building -r Other Impervious
Surface Percentage: I
■1
219123 Square Feet
0.2407
24.07 %
!
1
1,
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Land & Resource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
Shore Impact Zone Impervious
Building(s) Existing:50 Square Feet
0 Square Feet
0 Square Feet
Buiiding(s) Proposed:
Oeck(s) Proposed:
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
P Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
Deck(s) Existing:
Patio(s) Existing:
Sidewaik(s) Exisiting:
Landing(s) Existing:
Diiveway(s) Existing:
Parking Area(s) Existing:
Retaining Waii(s) Existing:
Landscaping Existing;
Misceiianeous Existing:
Totai Existing Imperious in the
Shore impact Zone:
Totai impetuous in the Shore
Impact Zone:
Patio(s) Proposed:
0 Square Feet
0 Square Feet
400 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
450 Square Feet
Sidewalks(s) Proposed:
Landing(s) Proposed:
Dtiveway(s) Proposed:
Parking Area(s) Proposed:
Retaining Watl(s) Proposed:
Landscaping Proposed;
Miscellaneous Proposed:
Total Proposed Impetuous in the
Shore Impact Zone:
^ Square Feet
Documentation
PLEASE NOTE PROPOSED
PROJECT AREA MUST BE STAKED
Attach Supporting Documentation:
r,-
File 1: image.jpg
File 2: image.jpg
Total Proposed Area to Determine 3100 Square Feet
Fee:
Applicant Approval
Harlow. Joseph R.Applicant Signature:
Date Signed:
Please check to approve:
02/04/2019
1 understand that checking this box constitutes a legal signature
Terms
Notes
The lot lines and project area(s) must be identified & staked onsite.
If project disturbs more than 1 acre of land, you must obtain a General Storm Water Permit from the MPCA.
Site Permit Terms
TWIS iS A SITE PERMIT ONLY AND DOES NOT CONSTTILRE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES
2/5/2019, 8:43 AM4 of 5
Land & Resource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
Agreement
} hereby certify that the information contained herein is correct and agree to do the proposed wodc in accordance with the description above set forth and according to the
pro\isions of the Ordinances of Otter Tail County, Minnesota.
i further agree that ariy plans and specifications submitted herewith shall become a part of this permit application.
Once Pennit is approved, I also understand that this pennit is valid for twelve (12) months Irom the date of approvel unless othenwise Indicated on permit.i!
Footings a1
I understand that it is my responsibility to Infonn the Land & Resource Management office once the building footings have been constmcted.
i\
Invoice 02/04/2019
Charge TotalQuantityCost
;iGrand Total
$0.00Total
il $0.00Due
Approvais
ii
'll Approval Signature
#1 Received and Assigried Sheila Dahl - 02/05/2019 8:13 AM199f35e00deed53f42f3eadeafdl85el
8fe8844c2e7c72e93375514dcc375bfl
#2 Pemill Review
#3 Permit Review \
tA Permit Issuance j
Public Notes
Text:
File(s):
Intemai Notes i!
1Text:
Rle(s):
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Gonditienal-yse-PermilH#-—
Owner’s Name Br<y LoJjc j Jbfstph ^ Use. Ih^^^ltud
Property Address H3lcO(e> P€xWmi st^sr^
Location: Lake No.5fci3o_ Sec. 1-7 Twp. I3(g Range Twp. Name Pt'i^ uKe
Pt- fetul itv_____________________________ ________
Work Authorized:AitA m gfu>\
4t> rJpy-kt<*<ia4- ljt)\rtuiir nt- 4-lfir 7.
L»c[o^?+
^ ; f2fc/o^ic/^ Z i>> /rc<<- / -hi h'^i^ Z>
<- 5Ar// /to Z. 0.^
ictuii^d j^luj^ cIclUJ f\)otwyiher ^o/(g
\j^jtx>\'l z/44^Valid:Expires:
Land and Resource Management Official / Date
1. Entire area shall be stabilized within 10 days of the completion of any earthmoving unless otherwise stated.
2. Owner is legally responsible for all surface water drainage that may occur.
3. If the terms of this permit are violated the entire permit may be revoked and the owner rnay be subject to legal prosecution.
4. This caird shall be placed in a conspicuous place not more than 4 feet above grade on the premises on which work is to be done,
anrl shall hR maintainpri thfire until nnmnletinn nf .<51 inh work.
5 ----
a Page 1 of‘1
OTTER TAIL COUNTY
Land & Resource Management
Phone (218) 998-8095
f
I
Site and Lot Alteration Permit
(combined)______________
iPERMIT TYPE PERMIT NUMBER 30339I
iPROPERTY OWNERIi|
LAKE INFORMATIONi:
DNR ID(S)
Joseph & Lisa Harlow
Big Pine
1
130
LOCATION !
!!
Parcel(s): 52000170112006
Township Name: Pine Lake Township
Property Address(es): 43606 MOSQUITO HEIGHTS RD
Section/Township/Range: Sect-17 Twp-136 Range-038
Legal: PT GL 1 COM W1/4 COR SEC 17 N 181.5' N 44 DEG E 350' S 45DEG E
316.35' i
20' S 36 DEG E
,'iWORK AUTHORIZED
Construct 98j4 sqft addition to Lodge for storage and walk-in cooler. Construct 2116 sqft deck with
accessibility Vamps to Lodge.
Kyle Westergard 02/26/2019 11:47 AM
fea580fc05d55b64ecc5ad928ee433cb)if94b793bf29ce79102b2c92a5d2966e4 02/26/2019 02/26/2020
Land and Resource Management Official/Date ISSUE DATE DATE EXPIRES
fNOTE:
• This permit must be placed in a conspicuous place not more than 6 feet abo^ve grade on the premisesj on which work is to be done, and must be maintained there until completion of such work.
• If the terms of this permit are violated, the entire permit may be revoked and the owner/contractor
may be subject to legal prosecution.
• Property Owner is legally responsible for all surface water drainage which may occur.
• Topographical Alteration projects shall be stabilized within 10 days of the completion unless
otherwise stated.
• Notify Land & Resource Management when building footings/foundation have been completed
and/or when work authorized is complete and ready for inspection (218) 998-8095.
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https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=5&app=5289 2/26/20191
I
Land & Resource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
Land & Resource Management
Government Services Center
540 Fir Avenue West
Fergus Falls MN 56537
Phone: 218-998-8095OTTER TflllO O Vlk T Y - m t « 0 11 o t«
site and Lot Alteration Permit (combined)
Permit #___
Applicant Information
!Applicant Infonnation:Name:!
Joe Harlow
Phone:
I r(218 )298 -23M i
Email Address
j ioehat1ow43606@gmail.com
) Mailing Address
43606 Mosquito Hts. Rd
Pertiam Mn 56573i
Property Owner1 am the:
Work Performed Bv (Site Permit)
Work to be performed by
(Site Permit):
Self
Work Performed Bv (Lot Alteration Permit)
Work to be perfonned by
(Lot Alteration):
Self
Property Information
Property
Please
search by
one of the
following:
Parcel #,
name, or Physical
Address.
Click the blue
"Select" to select
Selected:
Primary Name/AddressLegal DescriptionProperty Attributes Property Address
CityPrimary Address Line 1CityLegal Description Legal Description Legal Description NameParcel #Property Address
43606 MOSQUITO
HEIGHTS RD
PERHAM181.5'N 44 DEG E
350' S 45
DEG E 20' S 36
DEG E 316.35'
JOSEPH
& LISA HARLOW
43606 MOSQUITO
HEIGHTS RD
PERHAM PTGL 1 COM
W1/4 COR SEC
52000170112006
17 N
219123 Square FeetLot Area:
Is the
property
Developed or Undeveloped?
Developed
On Site
Sewage
Treatment
System:
L&R Cert, of Compliance within 5yrs.
Onsite Water Individual Supply:
(A
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2/5/2019, 8:43 AM1 of5
Land & Resource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
Shoreland Information
Associated Lakes:Selected:
Lake Name DNRID Lake Class LRCD
Big Pine 130 GD 56-130
Water Frontage;310 Feet
Bluff:No
Proposed Project (Site)
Addition to DwellingProposed Dwelling;
Is there an Attached Garage?
Proposed Non-Dwelling:
Proposed Water Oriented
Accessory Structure:
Deck(s)
None
Please list outside dimensions (in 2116 sq. ft deck. 984 sq. ft.
Lean to storage.feet)
of above Items you are applyingfor
Characteristics of Proposed Dwelling
New or Replacement:New
Square Feet:
Maximum Proposed Height:
^ Square Feet
25 Feet
50 FeetSetback to Lot Lines
(indicate closest lot lines):
200 Feet
Setback to Right of Way:
Setback to Ordinary High Water
Level:
50 Feet
175 Feet
10 FeetSetback to Septic Tank:
Setback to Drainfieid:50 Feet
Na FeetSetback to Bluf
Elevation above Ordinary High
Water Level:
16 Feet
0Total Bedrooms;
Roof Change:No
Characteristics of Proposed Deck
2116 Square FeetSquare Feet;\11 FeetMaximum Proposed Height:
Deck Stbck Lot Line 1
(indicate closest lot lines):
50 Feet
200 Feet
50 FeetSetback to Right of Way:
Setback to Ordinary High Water Level:
175 Feet
16 FeetElevetion above Ordinary High
Water Level:
10 FeetSetback to Septic Tank:
Setback to Drainfieid;100 Feet
Na FeetSetback to Bluff:
Proposed Project <Lot Alteration)
Project Type;Add lakeside elevated deck with entrance/exit accessibility ramp, and lean to addition to
second level for storage (walk in coolers, dry storage).
Project Description:Impervious
Surfece
Foundation Type:Post
Construction
Culvert and Road Authority
Culvert?No
NoRoad Authority Approval:
2/5/2019, 8:43 AM2 of 5
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Impervious Surface - Buildings
3100 Square Feet — li
0 Square Feet'
“ j)
0 Square Feetli
0 Square Feetli
0 Square Feet
Dwelling Existing:2880 Square Feet
0 Square Feet
0 Square Feet
2M0 Square Feet
^0 Square Feet
Dwelling Proposed:
Attached Garage Proposed:
Detached Garage Proposed:
Storage Shed Proposed:
Attached Garage Existing:
Detached Garage Existing:
Storage Shed Existing:
Water Oriented Accessory
Structure Existing:
Recreational Camping Unit
Existing:
Miscellaneous Existing:
Total Building Existing Impervious: 21^ Square Feetij
Water Oriented Accessory
Structure Proposed:
0 Square FeetE0 Square Feet
3100 Square Feet
13600 Square Feet Recreational Camping Unit Proposed:
2128 Square Feet Miscellaneous Proposed:
msmm Total Building Proposed Impervious:
Impervious Surface Calculation - Buildings
Total Building Existing Impervious: 216^ Square Feet
3|00 Square FeetTotal Building Proposed
Impervious:
Total Building Impervious Surfece: 247<^ Square Feet right
219123 Square Feet
: .
Lot Area:
5Impervious Surtece Ratio:0.1129
Buildings Impervious Surface ' 11;29 %Percentage:;/
Impervious Surface - Other
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
p Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
p Square Feet
0 Square Feet
Deck(s) Proposed:
Patio(s) Proposed:
Sidewalk(s) Proposed:
6800 Square FeetDeck(s) Existing:
Patio(s) Existing:
i
p Square Feet
150 Square Feet
200 Square Feet
15636 Square Feet
5213 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
27999 Square Feet
Sidewalk(s) Existing:
Landing(s) Existing:
Driveway(s) Existing:
Parking Area(s) Existing:
Landing(s) Proposed:
Driveway(s) Proposed:
Parking Area(s) Proposed:
Retaining Wall(s) Proposed:
Landscaping Proposed:
Retaining Wall(s) Existing:
Landscaping Existing:
Miscellaneous Existing:Miscellaneous Proposed:
Other Proposed Total:Other Existing Total:
■Impervious Surface Calculation - Buildings & Other
Total Building + Other Existing 49647 Square Feet
Impervious:
Total Building -*■ Other Proposed 3100 Square Feet
Impervous:
Total Building + Other Impervious 52747 Square Feet
Surface:
219123 Square FeetLot Area:
0.2407Building + Other Impervious
Sur^ce Ratio:
Building + Other Impervious
Sur^ce Percentage:
24.07 %j...
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Land & Resource Permit Applications
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https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
1
Shore Impact Zone Impervious
Building(s) Existing:^ Square Feet Building(s) Proposed:
Deck(s) Proposed:
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
0 Square Feet
Deck(s) Existing:
Patio(s) Existing:
0 Square Feet
p Square Feet
0 Square Feet
0 Square Feet
400 Square Feet
0 Square Feet
p Square Feet
0 Square Feet
0 Square Feet
450 Square Feet
Patio(s) Proposed:
Sidewalks(s) Proposed:
Landing(s) Proposed:
Driveway(s) Proposed:
Parking Area(s) Proposed:
Retaining Wall(s) Proposed:
Landscaping Proposed:
Miscellaneous Proposed:
Total Proposed lmper>ious in the
Shore Impact ^ne:
Sidewalk(s) Exisiting:
Landing(s) Existing:
Ori\eway(s) Existing:
Parking Area(s) Existing:
Retaining Wall(s) Existing:
Landscaping Existing:
Miscellaneous Existing:
Total Existing lmper\iious in the
Shore Impact Zone:
Total Impervious in the Shore
Impact Zone:
450 Square Feet
Documentation
PLEASE NOTE PROPOSED
PROJECT AREA MUST BE
STAKED
Attach Supporting Documentation:
-•- x-. ■ ,>.■ V
/// ''
File 1: tmage.jpg
1/
wn-.
File 2; image.jpg
Total Proposed Area to Determine 3100 Square Feet
Fee:
Applicant Approval
Harlow, Joseph R.Applicant Signature:
Date Signed:02/04/2019
I understand that checking this box constitutes a legal signaturePlease check to approve:
Terms
Nctes
The tot lines and project area(s) must be identified & staked onsite.
If project disturbs more than 1 acre of land, you must obtain a General Storm Water Penriit tiom the MPCA.
Site Permit Terms
mis IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORm IN CHAPTER 16, MINNESOTA STATE STATUTES
2/5/2019, 8:43 AM4 of 5
Land & Resource Permit Applications https://onegov.co.ottertail.mn.us/view.php?id=5289&viewOnly=l...
Agreement
I hereby certify that the information confainetJ herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the
previsions of the Ordinances of Otter Tail County, Minnesota.
I further agree that any plans and specifications submitted herewith shall become a part of this pemiit application.
Once Permit is approved. I also understand that this permit is valid for twelve (12) months from the date of approval unless otherwise indicated on permit.
Footings
my responsibility to inform the Land & Resource Management office once the building footings have been constructed.I understand that it is
Invoice 02/04/2019
Charge Cost Quantity Total
;i
Grand Total
$0.00Total
$0.00Due
iApprovals!
IjApproval Signature
#1 Received and Assigned Sheila Dahl - 02/05/2019 8:13 AM 199f35e00deed53f42f3eadeafdl85el
I8fe8844c2e7c72e93375514dcc375bf1
i#2 Pennit Review
#3 Permit Review
#4 Permit Issuance
Public Notes
Text:
File(s):
Internal Notes
iText:
File(s):
i
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SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and compufaf/ons
Ft.Structure Set Back from Quinary High Water Level Ft.
1 Ft.Ft.Structure Set Bade from Top of Bluff
Ft.Ft.Structure Set BaCK from Road Right of Way
Ft.&Ft.Ft.&Ft.Structure Set Badt from Lot Lines_______;___________«_____
Structure Height Ft.Ft.I
1Structure Set Bade from Septic Tank Ft.Ft.
Structure Set Back from Dirainfleld Ft.Ft.
Elevation Of Lowest Roor Above Ordinary High Water Level | ____Ft.Ft.
Land Slope at Building Site % %
Inspector's Comments t Sketch:
<(
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;
inapeaot^ S^natun
)1
Data Of Invfsaion i
1 . Time of fn^weSon
□ Pn^eet AppimaSOete/fnffiaf
i
• 'im-r:-'>1 !•
WHITE-Office
GOLDENROD - Inspector
YELLOW - Owner {after issue)
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENIER, 540 WEST FIR, FERGUS FALLS, MN 56537
www.co potter-tail.mn.ul
OTTCR TflllcoaaTT-aiiiiiciOTii
Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.
LAKE / RIVER NO.LAKE/RIVER NAME SECTION TWP NO.RANGELAKE/RIVER
CLASS TWP NAME0,a
PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS
iT vt>r ArL.n oV I fiL^AL DESCRIPTION DEVELOPED.
^ } First_________lnitia(j
T^l C£>U^^/UNDEVELOPED
Last Name Mailing Address Daytime Phone No.
'^/gProperty
Owner
V >
Contractor
Name
Llc.«\
NSITE SEWAGE TREATMENT SYSTEM )
( ) L&R Cert, of Compliance willllll 5 yiij.------------
ompliance Inspection Report within 3 yrs. (Attached)
( ) OTWMD 'Musi have Sewage System Approval
from OTWMD prior to issuing Site Permit.
Contact Roltie Mann at 218-864-5533
( ) New Septic Permit Issued
Permit #
PROPOSED PROJECT (please circle the appropriate number)
(1 ) New Dwelling
(4) MHA'R_____
(7) Add’n To Non-Dwelling (8 ) Storage Structun (10 ) Non-Conf, Replacement (identify)"_____j.
(11) Other (identify),
(12) Deck_
(13) Fence,
ONSITE WATER SUPPLY
(^ndividual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
(2 ) Add'n to Dwelling/Attached Garage ( 3) Replacement Dwelling*
(5) RCU/Year.. I Detached Garage*d(rl <4inA/.o,A.s,
f.
9
'Removal of Existing Dwelling Verified by L&R •’Existing Non-Conf. Structure Verified by L&R
Inspector's Initial/Date Inspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
CHARACTERISTICS OF PROPOSED DWELLING^ ^RACTERISTICS OF PROPOSE09BV9EEEm)»
(Must Include Attached Garage) ./^'Outside ^
Outside DimensionFt. x^Ft?*'^ Dimension — / — Ft. x —^/Ft. __—^
Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level ___
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield _
.Rptharit tn Rlr ift
Ft. X Ft."intSqFL.2gSO,-^t-
Setback to Lotline
Setback to Right of Way 3^ Ft."
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level
Setback to Septic Tank i‘*Q Ft.
Setback to Drainfield Ft.
Setback to Bluff
Maximum Proposed Height 35 Ft.
Roof Change ( )Yes ^.^^No
Bathroom Proposed ( ) Yes ( ) No
So Ft."FL
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff_____
Ft.&Ft."Ft.&F1.&Ft."Ft."
Ft."Ft.
Ft.Ft.
Ft.Ft.Ft.
Ft.Ft.
El^otal Bedrooms
Maximum Ptfiposed HeigTt
Pr,r,f rhnn^n ( ( ) NO
L Basement (jX! Yes^
^Walkout Basement
Ft.
Ft.Ft.Ft.
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
Ft.
)No ( ) Screen Porch
( ) Storage Structures (side profile required) ( ) No
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
y 21 Cubic Yards - 999 Cubic Yards*
Topographical Alteration / Earthmoving
□ None
' Must include on scale drawing,
additional Permit may be required.□ 20 Cubic Yards or Less *□ 1,000 Cubic Yards or More*
Bluff ( )YesCHARACTERISTICS OF LOT:Lot Area.Sq. Ft.Water Frontage Ft.
7. ^.%.%
Building Surface Ratio Impervious Surface Ratio
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. 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.
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 & Resource Man^g^ent office once the building footings have been constructed.
7 I - O _Signature ofProperty Owner / Ag0nt for OwffSf , ^
'SottpeMvfSmxment OfficialPERMIT FEE $ ^
Date:
-7-Date:
La7Rr3r^s
Comments: f-, I_______,________________ _______
04-'
-fe-pn g bfp.ifccH(A| lYYlo/t-p^l
PROJECT(S) TOTAL SQ. FT.RECEIPT NO.
Date Stamp RECEIVED
JUL 3 ^ 2017
UNB& RESOURCE
L&R InitialForm No. BK — 04-2016 360,647 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota
m
APPLICATION FOR SITE PERMIT WHITE - Office
GOLDENROD - Inspector
YELLOW - Owner (after issue)
r
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.usOTTCR Tflll
APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.
couaTT-BianKOTfl
Permit No.
LAKE / RIVER NO.
I
LAKE/RIVER NAME LAKE/RIVER
CLASS
V' N
SECTION TWPNO.RANGE
1
TWP NAME
'J
\ . “I -r
PARCEL NUMBER (S) PROPERTY (E-911) ADDRESS
vl>) rU.("? o \ I
LE^AL DESCRIPTION
T rsiu DEVELOPED.
UNDEVELOPED.
InitialLast Name Mailing Address Daytime Phone No.
V"/ ^ *-wJ ^ r ' T ^
Property
Owner
\
da;£^/ZliIContractor
Name
Lie.#
V-
VJONSITE SEWAGE TREATMENT SYSTEM J
r~)TW”Cefrof’^ompITande'WIttTltr^yre."' ^
PROPOSED PROJECT {please circle the appropriate number)
{1 ) New Dwelling
( 4 ) MH/YR____
( 7 ) Add'n To Non-Dwelling (8) Storage Structun
(10) Non-Conf. Replacement (identify)"_____
(11) Other (identify)
(12) Deck.
(13) Fence
ONSITE WATER SUPPLY
Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
( 2 ) Add'n to Dwelling/Attached Garage (3) Replacement Dwelling*
(5) RCU/Year.i^j^ompliance Inspection Report within 3 yrs. (Attached)
{ ) OTWMD 'Must have Sewage System Approval
from OTWMD prior to issuing Site Permit.
Contact Roilie Mann at 218-864-5533
( ) New Septic Permit Issued
Permit #
____ ^ . Jc6) Detached Garageire i 'if-X (f)YI/.O.A.S.
—4g\\HZ9
‘Removal of Existing Dwelling Verified by L&R •’Existing Non-Conf. Structure Verified by L&R
Inspector's Initial/Date Inspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
CHARACTERISTICS OF PROPOSED DWELLING QHfc
(Must Include Attached Garage) -Outside
.FT'S,
RACTERISTICS OF PROPOSED
Ft.x rf?Ft.**^W^-^-^
DimensionOutside Dimension___
Sq. Ft.
Setback to Lotline ____
Setback to Right of Way
Setback to Ordinary Fligh Water Level ___
Elevation Above Ordinary Fligh Water Level
Setback to Septic Tank
Setback to Drainfield _
.,S.etbackJ;CLailJfi_
(■ Total Bedrooms rd j
M’axTftiPTri'PropgSSd FleioTlT ' ^ Ft.
( )No
Ft. X Ft. X Ft.**Sq. Ft. 2860Jb-Cry Ft.**Ft.&Ft."Setback to Lotllne Ft.& ^
Setback to Right of Way Ft."
Setback to Ordinary Fligh Water Level
Elevation Above Ordinary Fligh Water Level ^ Ft.
Setback to Septic Tank { 0 Ft.
Setback to Drainfield Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary Fligh Water Level __
Elevation Above Ordinary Fligh Water Level
Setback to Septic Tank___
Setback to Drainfield____
Setback to Bluff
Maximum Proposed Fleight
Ft.&Ft.”Ft.”
Ft."Ft.
Ft.Ft.
Ft.Ft.
Ft.Ft.
Ft.
Setback to Bluff Ft.Ft.'? r"Maximum Proposed Height Ft.
Roof Change ( )Yes (,<^>sfNo
Bathroom Proposed ( ) Yes ( ) No
0 Ft.^EtooiObango ( ■ ) Y
Basement (Xj Yes, ,
Walkout Bremen" (V)Jb
)No ( ) Boathouse
( ) Gazebo
( ) Screen Porch
( ) Storage Structures (side profiie required) ( ) No
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
•y 21 Cubic Yards - 999 Cubic Yards*
0.01 (\cx V
Topographical Alteration / Earthmoving
□ None
* Must include on scale drawing,
additional Permit may be required.□ 20 Cubic Yards or Less *□ 1,000 Cubic Yards or More*
to Bluff ( )Yes (A) NoCHARACTERISTICS OF LOT:Lot Area.Sq. Ft.Water Frontage Ft.
.%.%
Building Surface Ratio Impervious Surface Ratio
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. 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.
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 & Resource Manag^ent office once the building footings have been constructed.
Date:7 'Z I ' I ^7 Si^ri^r^^Properiy Owner / AgSnt for Ownor _
ioufoo Matl^^ment Official ^
PERMIT FEE$ ^- q1Date:/Lanrttrffes
3a n-107)PROJECT(S) TOTAL SQ.FT.,RECEIPT NO.
oComments:
—— Tof b/ifi
-krC/n g Ip Yr.t^ I. A,I I vy I uri L/vO
Form No. BK — 04-2016 360,647 • Victor Lundeon Co., Printers • Fergus Falls. Minnesota
\
r »
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
^ lx>o
Structure Set Back from Ordinary High Water Level Ft.Ft.
Structure Set Back from Top of Bluff Ft.Ft.
|o()5Structure Set Back from Road Right of Way Ft.Ft.
SO^Structure Set Back from Lot Lines Ft.&Ft.Ft.&Ft.
3i> "'I'Structure Height Ft.Ft.
Structure Set Back from Septic Tank Ft.Ft.
Structure Set Back from Drainfield Ft.Ft.
Elevation Of Lowest Floor Above Ordinary
High Water Level ^3 -Ft.Ft.
Land Slope at Building Site %%
» I -• V-Inspector’s Comments / Sketch:
4
I
I
rJjsb
/V.
Inspector’s signature
Date of Inspection
Time of Inspection
ApprovedDate/Initial ^
SCALE DRAWING FORM
Tax Parcel Number(s)
The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/or proposed structures, septic
lust alsoT»«)^te thetanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, wells, wetlands and topographic features (i.e. blujjj
Impervious Surface Calculation (see back).(
Scale
I\
44
RcGttVbD
JUL 3 i 2017
LAND & RESOURCE
,r—?«»
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/I
^ %o~r
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I Signature of Property Owner i Date
BK —042016 360,800 • Viclor LundSen Co.. Printers » Fergus Falls. MN • 1-800-346-4870
IMPERVIOUS SURFACE CALCULATION
List & identify all existing & proposed onsite impervious surfaces on scale drawing.
Lot Area (ft^): 0'C>^C>Q> ^
Buildings Other Impervious Surface
Existing Proposed Existingr-i.2 Proposed
Ft^Ft^Ft Ft
ftf9-S goDwelling Deck(s)
Attached Garage Patio(s)
Detached Garage Sidewalk(s)
Storage Shed Landing(s)
WOAS Driveway(s)
JTOO
^cOz>
RCU 9^e>oohHooParking Area(s)U<?
Miscellaneous
AV -cr ViC* «ji> X
Retaining Wall(s)/
yxc Landscaping
(Plastic Barrier)
^ oii '-.t Miscellaneous
5’4>odU.TOTAL BUILDINGS TOTAL OTHER
Buildings
Impervious Surface
Percentage
Maximum Allowable 20%
Existing Proposed Total Lot Area Impervious
Surface
Ratio
Ft^ Ft^ Ft^Ft^Total Buildings
sysi^, OnL,100+T-=x
Buildings + Other
impervious Surface
Percentage
Maximum Allowable 25%
Total
Buildings + Other
Impervious Surface
Existing Proposed Total Lot Area Impervious
Surface
Ratio
Ft^ Ft^Ft^ Ft^
^0.1o 0^100+-r =X =
Impervious Surface Calculation Worksheet 04-11-2016
fy ..Signature:Date
i
Ml
i-
'
ir
!
!
;
I
WHITE-OfTice ,
GOLDENROD - Inspector
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
YELl-OW - Owner (after issue)
PINK - Assessor
Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.
77TWP NAMESECTIONTWP NO.RANGELAKE/RIVER /
CLASS \/KE/RIVER NAMELAKE / RIVER NO.l/
J> * V."S o 6-0
PROPERTY (E-911) ADDRESS/PARCEL NUMBER (S)
53L 0430
YA' totK \A]V4 T/O/M n\ k1
I oet woma Pirct Initial / Mailing Address '7
LEGAL DESCRIPTION
Daytime Phone No.Last Name
»e ^/aProperty
Owner Ar'S sA
Contractor
Name
Lie.#
PROPOSED PROJECT (please circle the appropriate number)ONSITE SEWAGE
TREATMENT SYSTEM
( ) L&R Cert, of Compliance within 5 yrs.
Compliance Inspection Report within 3 yrs. (Attached)
ONSITE WATER SUPPLY
(>^ndividual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
(*Jl) ^ililii*" DwHIroj (3) Replacement Dwelling*
(6) Attached / Detached Garage
(9) W.O.A.S.
(1 ) New Dwelling
( 5 ) RCU/Year_____
(7) Add’n To Non-Dwelling Storage Structure
(10 ) Non-Conf. Replacement (identify)"________
(11) Other (identify)_____________________
(12) Deck____________________________
(13) Fence___________________________
(4) MH/YR.
jliJlj^TWMD ‘Must have Sewage System Approval
y from OTWMD prior to issuing Site Permit.
~ Contact Rollie Mann at 218-864-5533 ,\yjLCpKip 4 ■ |g»|
"Existing Non-Conf. Structure Verified by L&R•Removal of Existing Dwelling Verified by L&R
Inspector's Initial/DateInspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside ,, ^Dimension ^ Ft. x 'A Ft.**
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
Ft.xOutside Dimension _Sq. Ft._2^^
Setback to Lotlirhsi /^O Ft. &
Setback to Right of Ww
Setback to Ordinary HigKWater Ft.
Elevation Above Ordinary Hlgh/Water Level
Setback to Septic Tank tJo
Setback to Drainfield
Ft."Ft. Xy/Sq. Ft.
Setback to Lotline SS
~ j|(^etback to Right of Way
PI Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level '3 a
L Sq. Ft.
Setback to Lotline___
Setback to Right of Way
V Setback to Ordinary High Water Level __
' Elevation Above Ordinary High Water Level
Ft. & y Ft.**
Ft.” ^
Ft.**
Ft."Ft.&
Ft.”
Ft.
Ft.Ft.
Setback to Septic Tank Ft.
Setback to Drainfield pt. '
Ft.Setback to Septic Tank
Setback to Drainfield _
Setback to Bluff
!o__Ft.Setback to Bluff jin!
Total Bedroomy^ 5
Maximum Pf($posed Height
ip Roof Cl7e(>C) Yes ( ) No \
Baspifient ( )Yes (<)No
-iTOlkOUt Basement ( ) Yes (side profile required) (
Ft.9^ FtVNSetback to Bluff
Maximum Proposed Height
Ft.
Ft.Maximum Proposed Height
( ) Boathouse
( ) Gazebo
Roof Change ( ) Yes (>^) No
Bathroom Proposed ( ) Yes ( ^ No y ( ) Screen Porch
( ) Storage Structurelo
**Project/Lotlin^Right-of-ways Must be Staked Onsite Prior to Application / lns|>ection
cV
21 Cubic Yards - 999 Cubic Yards*
* Must include on scale drawing,
additional Permit may be required.
Topographical Alteration / Earthmovina
□ None □ 20 Cubic Yards or Less [jfcV.OOO Cubic Yards or More*
3ZOCHARACTERISTICS OF LOT:Ft.BluffSq. Ft.Lot Area.Water Frontage
.%
Impervious Surface RatioBuilding Surface Ratio
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. 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.
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 & Resource Manaopment office once the building footings have been constructed.
9~/Q {1>Date:
Signature OT Propet^Owner / Agent for Owner
IQ 3 —tDate:
Land & Resound Management Official tHP-iogr? tAsigl
PERMIT FEE $RECEIPT NO.PROJECT(S) TOTAL SQ.FT.
Z\yJ
T**-/
\nComments^^;^ G\>jirv<Lv
VuIWv'vjV. v»i\\\
Date StampVvC,
A1ruv^'v
■W \|3+ro«v<S, o Qy-v
• It^nnesota
L&lTfInitiali4>t^Form No. BK — 08-015-2013 352,196 • Victor Lundeen Co.. Printers ■7T7
V # .
■? ■
WHITE^-OfficQ^
GOLDENR^D hnspector
YELLOW - Owner (after issue)
PINK - Assessor
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
Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.
177TWP NO.RANGE TWP NAMELAKE/RIVER . CLASS \/
SECTIONLAKE / RIVER NO.r LAKE/RIVER NAME V'/*\jCN"?i
7PROPERTY (E-911) ADDRESSPARCEL NUMBER (S).//
5 a 0430 n X oo4 H36c34 hfoS&K>tirtA UtS
(y\^\ C>o(A \/aV4 r>o/ ^^0. l~l n\ \^L^' kI >
Last Name First Initial / Mailing Address
LEGAL DESCRIPTION
Daytime Phone No.
^Il6^ 4-i7i .Sait PK____^ / :S S SProperty
Owner
\Sm OLM*
ay 1
^FiAf0Contractor
Name
Lie.#
!
PROPOSED PROJECT (please circle the appropriate number)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
( ) L&R Cert, of Compliance within 5 yrs.
(s/ Compliance Inspection Report within 3 yrs.
A (Attached)
OTWMD ‘Must have Sewage System Approval
'/ horn OTWMD prior to issuing Site Permit.
p, Contact Rollie Mann at 218-864-5533
tn Pwcllinp t (3 ) Replacement Dwelling*
(6 ) Attached / Detached Garage
(9) W.O.A.S.
(1 ) New Dwelling
( 4) MHA'R_____( 5 ) RCU/Year______
{7) Add’n To Non-Dwelling ^ Storage Structure
(10 ) Non-Conf. Replacement (identify)''_________
(11) Other (identify)________________________
{12 ) Deck________________________________
(13) Fence_______________________________
••Existing Non-Conf. Structure Verified by L&R•Removal of Existing Dwelling Verified by L&R
Inspector’s Initial/DateInspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
Outside Dimension Ft. x ^1 py'
So. Ft.
Setback to Lotlifta /<Po Ft. &
Setback to Right oHNw '5*ft* Ff **
Setback to Ordinary HigKWater Ljv& Ft.
Elevation Above Ordinary FItgJjAftfater Level_
Setback to Septic Tank > AT
Setback to Drainfield
Setback to Bluff ^VO Ft.
Total Bedrooms.*''
Maximum P_foposed Fleight
Roof Chpfige (x ) Yes ( ) No
Baspm'ent ( ) Yes () No
Walkout Basement ( ) Yes (side profile required)
CHARACTERISTICS OF PROPOSED NON-DW^LING
Outside
Dimension Ft.^^..T>Ft.x Outside
Dimension Ft. x Ft.^^
Sq. Ft. S-UaO
Setback to Lotline 5 5 Ft. & Ft.^^
Ft.-*^
7 Sq. Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank__
\Setback to Drainfield____
Setback to Bluff________
Maximum Proposed Height
Ft.^^
Ft.**Ft.&
•"“■l^etback to Right of Way
P Setback to Ordinary High Water Level VCt> Ft.
Elevation Above Ordinary High Water Level ^ S* Ft.
Setback to Septic Tank 'X'P Ft.
Setback to Drainfield ^ Ft. '
/Ft.**
Ft.
Ft.Ft.7 Ft.
Ft.4
Setback to Bluff Ft.
Maximum Proposed Height 2^
}
Ft.
Ft.
Roof Change ( ) Yes (X) No
Bathroom Proposed ( ) Yes ( >0 No 7 ( ) Boathouse
( ) Gazebo
**Project/Lotlinds/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
( ) Screen Porch
( ) Storage Structure
i
7QrVp
* 21 Cubic Yards - 999 Cubic Yards*
#
Lot Area ^ ^ q
>5T
Topographical Alteration / Earthmovinq
□ None □ 20 Cubic Yards or Less
* Must include on scale drawing,
additional Permit may be required.|||^,000 Cubic Yards or More*
CHARACTERISTICS OF LOT:Sq. Ft.Water Frontage
.%
Building Surface Ratio Impervious Surface Ratio
TH/S /S 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. 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.
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 workipen 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 responsibiiity to inform the Land & Resource Management office once the building footings have been constructed.
Date:~ f d - \ ~j___________________ ________ ‘ y ________
Signature 0f Properi^Owner / Agent for Owner /
___i {y' '4 7
Land & Resource iManagement t)fficial
I o -•g- 3 —fDate:—f--------- 4/
^I o^D RECEIPT NO. fio'y? ‘PERMIT FEE $PROJECT(S) TOTAL SQ. FT.,
iV-.C vV • 7■A-kCommentsi^ll;^ <>■ \ r-
\4VXV'-ArV V\\\ CL.
11w>
W.-ro*x<S. ;1 ^ Ov^
W)'lisaForm No. BK — 08-015-2013 352,196 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota
* ■•in*.
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
Hoo'^Structure Set Back from Ordinary High Water Level Ft.Ft.
Structure Set Back from Top of Bluff Ft. Ft.
Structure Set Back from Road Right of Way Ft. Ft.
Ft.&Structure Set Back from Lot Lines Ft.Ft. &Ft.
Structure Height Ft. Ft.
Structure Set Back from Septic Tank Ft. Ft.
Structure Set Back from Drainfield Ft. Ft.2^^
Elevation Of Lowest Floor Above Ordinary
High Water Level jd Ft.Ft.‘
Land Slope at Building Site I,% %
Inspector’s Comments / Sketch:
a On a,/ CeUr* ^ S LJ
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Insp^ors Signature
b’l-u-z-jiU
Date oA Inspection
Time of Inspection
Ok^oject Approved
DatS’^/Initial ^
APPLICATION FOR GRADE & FILL PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
TWP NAMESECTIONTWP. NO.RANGELAKE/RIVER
CLASS
LAKE/RIVER NAMELAKE/RIVER #
n
PROPERTY (E-911) ADDRESSPARCEL NUMBER(S)
S~x ooo i ^7 ^ V I Xoo V- H-rt P-eA A2 I
LEGAL DESCRIPTION
0A^\ ra\tA \1\\|4 (LfiifStMlNi
Last Name ' ' First Initi DAYTIME Phone No.Mailing Address
K X)%
Lfi > 7/- /•
Property
Owner r tc>U_i
Scl?Contractor
Name
Lie.#
Date Stamp
NOTES: 1. The lotlines and project area(s) must be staked.
2. If project disturbs more than 1 acre of land you
are required to obtain a General Storm Water
Permit from the MPCA.
L&R Initial
PROJECT REQUEST (You may use the grid on back for required scale drawing):
s V-o ki o''S'YoT «\ y;. ^DESCRIBE YOUR PROJECT(S): _31.,/IS C<^
/an\ 1^ c/ cmaIS^$>w i/s.d cjC) ^CO^x 5*7*^ fL t H- ro.
DETAILED INFORMATION:-
AREA TO BE CUT/EXCAVATED:lo u(^ X Ft. - 27 = Yds^Ft. XFt. X
Width Ave. DepthLength
Yds"Ft. - 27 =Ft. XWALK-OUT BASEMENT PROJECTS:
(Outside of the building foundation)
Ft. X
Ave. Depth
8 CD Ft. x_3^ . Ft. X ^ Ft.
Ave. Depth
TOTAL EARTHMOVING REQUESTED =
Length Width
X O \ Yds"AREA TO BE FILLED/LEVELED^- 27 =
Length Width
5lSJ_ Yds"
Ft.BACKFILL AT FOUNDATION;Ft.
Distance From FoundationMax. Depth
CULVERT:If Yes, must indicate size and location on drawing.
Yes No
ExistingIMPERVIOUS SURFACE: Proposed
Scale Drawing along with detailed impervious surface calculation must accompany this Application.
^IGNAtURE OFISROPERTY OWNER/AGENT FOR OWNER
BK082013
RECEIPT NUMBERDATE
IMPERVIOUS SURFACE CALCULATION WORKSHEET:
List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing);
r <; f' C■
Ft2Structure(s):
( ««
ODeck(s): \ ^Ft2 ''S f< 'j ^
V -O Ft2 o o ^Driveway(s):6 Uj -^r
c\Ft2 k ooiPatio(s):\-C V S ^a>0
3^ S 8*
J
^ 6 <t «» <> f\2 \Sidewalk(s):1
SU - rf- ^^'Pf J P I 4,0-7 IFt2Stairway(s):
/ S>d ^/^3 0
- ,
Ft2Retaining Wall(s):s ''C' r r' J <
’ O
Ft2 ' "'o'Landscaping:
(Plastic Barrier)
Other:Ft2
r f !
/ !, A.* oFt2TOTAL IMPERVIOUS SURFACE:
Ft2LOT AREA:acres
/ '7 ..%X100 =
IMPERVIOUS SURFACE RATIOLOT AREATOTAL IMPERVIOUS SURFACE
)cx^ V
, 6 ) ^ -^.,3-
r • n -c^c,f\/, 0
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V I ^ Ci\/
^ - r-, rf- 'j »/y O »
-4- t -U-:!!i il 1- 'IA
SCALlEDRAWINGiFORIV —I
4-M-t-t
S > a t V ^ 00-4
Tax Parcel Number(s)
The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/or proposed structures, septic
tanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, wells, wetlands, topographic features (i.e. bluffs), and onsite impervious surface
calculations.
/3.%
Scale Impervious Surface Ratio
(Must Complete Worksheet On Other Side)
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CP -Iof:I...r <—4-
bateSignature'bf Property Owner■ i i I i ^i ! *■[HH-Irr--i
Fergus Falls. MN- ...J-800-346-^870 .....................
II I •••..Victol LundecnBK^I0909 1 .338,596 Co, PrtntCfS -I "frI! ; i Q n !-!I!I..r]-T~ri f I ■II I I I II
PL/IT or SURREY
L ELS/-/ORE TRACTS IN
6VV: t OT 1, 5 EG. R.G8 W.
OTTER TAIL COUNTY, MINN ES OTA
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GRADE & FILL APPLICATION RECEIVED
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 0 1 2004
218-998-8095 www.co.otter-tail.mn.us IAND& RESOURCE
PERMIT NO
*■ ■ , i{...
Application Fee
Receipt Number
PROPERTY OWNER PA I ^ - A-V)'lc.e ReSo<~7~'
MAILING ADDRESS Lf36o6 Au iTa Uia h Tx
CITY, STATE, ZIP ^ hn.
Rl
^ T-Lr^
DAYTIME PHONE NUMBER 3 ^S
LAKE NO.CLASSLAKE NAME f
PARCEL NUMBER (S)
SECTION / 7 TWP <J^> 4/ RANGE ^ TWP NAME ^ 4 X k'qJ ~T^ R
LEGAL DESCRIPTION
E-911 PROPERTY ADDRESS
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
L&R Official DATE
PROJECT REQUEST (provide the scale drawing on back):
//O FT. MAXIMUM DEPTH OF FILL:MAXIMUM DEPTH OF CUT:FT.
)20 ^ d s YDS^TOTAL CUBIC YARDS OF EARTHMOVING REQUESTED:
DESCRIBE YOUR PROJECT BELOW:
lOstM. like h hAve ei^siV uAjI OA ^oo4
SIGflATURE OF PROPERTY OWNER/AGENT FOR OWNER
P-S^G-
DATE
BK0404
318,312 ■ Vidor Lundeen Co.. Primers • Fergus Falls, Minnesota
rhn
Scale
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DateSignature
BK — 0404 — 029 318.312 • Vctof Lundeen Co_ Prirtsrs • Ferous Falls. MN • 1-800-346-4870
Grade & Fill Permit #N2 sbts
v(oPROPERTY OWNER V - r-*>-s.q«^V
A>-LAKE NO. ^-t3o Lk. .SEC. < 1 TWP. NAME
LEGAL DESCRIPTION;
V>X,\N\v^i^ r'v>ipUV *-5C’tvV\KNWORK AUTHORIZED 3
Y^«>'4-VsJt"TTxxZ' ^ V-»V\V \i«_C>>Vg\»N A.or\
» +f=1 H <-X».^’Vir\v <^v‘^ T«»w O C'C't 4“o ArWv.v/»*w V f wCv v“ e/ s»
ot Cl 11\VjL i ZP CJ>^
•. <V n»^wvWn^
NOTE: This card shall be placed in a conspicuous place not more than 4 feet above grade on the premises on which
work is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MAN
AGEMENT, 218-739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED.
1. EARTHMOVING SHALL BE DONE BETWEEN S- M^-ov|
2. Entire area shall be stabilized within 10 days of 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 public water without a valid permit from the
MN 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.
04/22/04 THU 16:01 FAX 612 783 1824 SATURN MOUNDS VIEW @001
k.
GRADE & FILL APPLICATION
LAND & RESOURCE MANAGEMENT. COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER. 540 WEST FIR. FERGUS FALLS, MN 56S37
218-998-800S
www.co.otter4aB.nwMM
V
A PERMIT NO.AppIcattonFoa
Rocoipt Numbor
PROPERTY OWNER
MAILING ADDRESS.O '
CITY, STATE. ZIP
DAYTIME PHONE NUMBER _
Pi*A-g CLASSLAKE NO.LAKE NAME
PARCEL NUMBER (S).
SECTION ^^CEIVED
2 3 2004
^NDS resource
n TWP ^ RANGE_2&-bL TWPNAME
LEGAL DESCRIPTION
E^1 PROPERTY AD0RES8__;^
Rscoivod
DATEUnOHIbW
PROJECT REQUEST (PROVDE the scale drawing ON BACK)
FT*CUT AREA:FT, X.FT. -
FT*FT. ■rax AREA:.FT. X.
FT.MAXMUM DEPTH WCUT.-FT. MAXnniM DEPTH OF FILL:.
.YDS*TOTAL CUBIC YARDS OF EARTHMOV1NQ REQUESTBD;
DESCRIBE YOUR PROJECT BELOW
too-oL- Vo S-Jll ^ €t.-cpf>0 CjJhV
V Oo^ .
>o
ro<«-cf "*Tvr»' ^ifoti*'
O-/
LTURt OP PNOPeCTY OWNBVAOeiT FOR (MMat
BKIOn
04/22/04 THU 16:01 FAI 612 783 1824 SATURN MOUNDS VIEW @002
' l '.EXHIBIT TO REAL ESTATE MORTGAGE
Dated March 31, 2004
That part ot GovernmanI Lot 1 of Section 17, Township 136 North,
Range 38 West of the Fifth Principal Meridian in Otter Tail County,
Minnesota, described as follows; Commencing at a found iron
monument which designates the west quarter corner of said Section 17;
thence North 00 degrees 03 minutes 25 seconds West 181.50 feel on an
assumed bearing along the west line of said Section 17 to a found iron
monument; thence North 44 degrees 20 minutes 49 seconds East
350.38 feet to a found iron rr:onument; li’ianca Scuih degrees 23
minutes 34 seea.nds East 20.00 feet to an iron monument; thence South
36 degrees 23 minutes 17 seconds East 316.35 feet to the point cl
beginning: thence North 36 degrees 23 minutes 17 seconds West 315.35
feet to an iron monument: thence North 44 degress 20 minutes 49
seconds East 189.51 feet to a found iron monument' thence South 45
degrees 26 minutes 34 seconds East 40.00 feet to a found iron monument; thence South 44 degrees 1S~r^nutes 30 seconds West
146.36 feet to a found iron monument hereinafter referred to as Point C;
ihence South 45 degrees 34 minutes 50 seconds East 96.00 feet to a
found iron monument; thence North 44 degrees 22 minutes'^ seconds
East 251.31 feet to an iron monumeni; thence North 45 degrees 20 minut^ 30 seconds West 28.00 feet: thence North 44 degrees 20
minutes 49 seconds East 60^ feet; thence North 40 degrees 04
minutes 43 seconds East 15^0 feet, more or less, la the water's edge
of Big Pine Lake; thence sout?ieasterty ^ong the water's edge of said Big
Pine Lake to the northwesterly line o^'Pdvarty Beach, said plat Is on file
and of record the office of the Recorder of said County; thence
southwesterly along the northwesterly line of said Poverty Beach to the
most westerly comer of said Poveny Beach; thence westerly 250 feat,
more or less, to ttie point cf beginning. Subject to part of the foITowing
described driveway easement over, undur and across part of the above
tract described as follows: Beginning at a found iron rr.onument at the
aforemeniloned Point C: thence North 45 degrees 34 minutes 50
seconds West 60.22 feeq thence North 44 degrees 20 minutes 43
seconds East 24.00 feet; thence South 45 degrees 34 minutes SO
seconds East 36.X feel; thence North 87 degrees 15 minutes 47
seconds East 35.46 feet; Ihence South 44 degrees 15 minutes 30
seconds West 50.00 leet to the point of beginning of said driveway
easement.
SOBJECT TO a 10-foot-^ide lamited access easemeiit created by that certain Agreement dated April 4, 1996, filed for
record Hay 1, 1996 ais Document Ho. 790021:
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Grade & Fill Permit #2095
CPf ~Dl^£ fiesoAV)PROPERTY OWNER LnnAei (SOOLe.e
LAKE NOy^'/30 SEC. /7
7iA- A
TWP. /J^ TWP. NAME PlN£ Lah^.
Pt afi <ZL *!
^/iLLCa /^73 O i~£
LEGAL DESCRIPTION:
WORK AUTHORIZED Q fiUKA CAusn^O ^tJ e^STlhf^ ^Cl'%
'T^Ahf AAcu»4^ AAEA
3p^ THC LAUe /it^o (g) A/ice CL€Ar^ c^asu Rock (3‘-S'**)
0»^ £y^tsT)»/C ^ /Ji\ 30 ) 6^aT AAfirifi
iJi> CAusae/i asphact /^/>y a£ PLfi<.£o u/tTHt*^
NOTE: This card shall be placed in a conspicuous place not more than 4 feet above grade on the premises on which
work is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MAN
AGEMENT, 218-739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED.
EARTHMOVING SHALL BE DONE BETWEEN.
2. Entire area shall be stabilized within 10 days of 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 public yvater without a valid permit from the
MN 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.
APR—29—99 99:09 AM RERHAM.RRINTZHC 2 18 9399 P . 9 1
Fax Note 7672 No o* Pagos Today's
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Location
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Dept. Charge
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