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Home My WebLink AboutBladow Beach_53000230138000_Shoreland Permits_ (2)OTTER TAIL ^ O U N T Land & Resource Management 1 Phone (218) 998-8095 php?chttps://onegov.co.ottertall.mn.us/admsp»li10/8/2020 31501PERMIT NUMBERSITE AND LOT ALTERATION PERMIT (COMBINED) PERMIT TYPE PROPERTY OWNER Laik-n-brickmar Lie RushLAKE INFORMATION 141DNR ID(S) LOCATION Parcel(s): 53000230138000 Township Name: Rush Lake Township Property Address(es): 36052 RUSH LAKE LOOP Section/Township/Range: Sect-23 Twp-135 Range-039 Legal: 5.00 AC SUB LOT 1 OF GOVT. LOTS 3 & 4 WORK AUTHORIZED Remove concrete from 2 RCU sites and replace with 1. Remove cabin and replace with 20' X 24' cabin. Add 12' X 14' porch to main dwelling(non rental). Kyle Westergard 10/08/2020 02:09 PM 0cb96796020e75c01a6578694bf28251 537187c1617d3a99ddaa663e914d18a1 10/08/2020 10/08/2021 DATE EXPIRESLand and Resource Management Official/Date ISSUE DATE NOTE: • This permit must be placed in a conspicuous place not more than 6 feet above grade on the premises 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. https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=5&app=13866 1/1 Land & Resource Permit Applications10/8/2020 r Land & Resource Management Government Sendees Center 540 Fir Avenue West Fergus Falls MN 56537 Phone: 218-998-8095OTTER TflIIoovnTTminniioiii Site Permit Applications SITE AND LOT ALTERATION PERMIT (COMBINED) Permit # 31501, App. # 2065, UID it 13866 Valid: 10/08/2020 -10/08/2021 Applicant Information Applicant Information;Name Jeremy Bladow Phone' (2^8 )770 -5994 Email Address: info@bladowbeachresort.com Mailing Address: 36052 Rush Lake Loop Ottertail MN 56571 I am the:Property Owner Work Performed By (Site Permit) Work to be performed by (Site Permit): Self Work Performed By (Lot Alteration Permit) Work to be performed by (Lot Alteration); Self Property Information Project Location: Property Attributes Property Address Primary Name/AddressLegal Description Parcel #Property Address City Primary Address Line 1 CityLegal Description Name 53000230138000 OTTERTAIL36052 RUSH LAKE LOOP OTTERTAIL LAIK-N-BRICKMAR 36052 RUSH LAKE LOOPLLC Lot Area:188223 Square Feet DevelopedIs the property Developed or Undeveloped? On Site Sewage Treatment System: Compliance Inspection Report within 3 yrs. Onsite Water Supply NOTE; MN Rules Chpt. 4725 (MN Welt Code) requires a 3' (minimum) structure setback to a well. Individual Shore land Information Associated Lakes: Lake Name DNR ID Lake Class LRCD Rush 141 GD 56-141 Water Frontage:310 Feet Bluff;No Proposed Project (Site) Proposed Dwelling:Single Family Addition to Dwelling Is there an Attached Garage? Proposed Non-Dwelling; Proposed Water Oriented Accessory Structure: Please list outside dimensions (in 14x12 add. and replace cabin 20x24 feet) of above items you are applying for No l^ne None https://onegov.co.ottertail.mn.us/view.php?id=13866#outer_wrapper 1/4 Land & Resource Permit Applications10/8/2020 Characteristics of Proposed Dwelling • ,New or Replacement:New Square'Feet: ;Maximum Proposed Height; Setback to Lot Lines (indicate (2) closest lot lines); 168 Square Feet 14 Feet .1 28 Feet 250 Feet Selback’lo Right of Way: Setback to Ordinary High Water Level: 250 Feel 102 Feet 93 FeetSetback to Septic Tank: 228 FeetSetback to Drainfield: 0 Feet 5 Feet' Setback to Bluff; Elevation above Ordinary High Water Level: r 0Total Bedrooms:I Roof Change:Yes Proposed Project (Lot Alteration)■. Impervious Surface Project Description:adding a 14x12 add. inplace of deckProject Type; Foundation Type:Floating SlabCrawlspace i Area to be Cut/Excavated Length:' .‘" OFeetTotal Cubic Yards:00 Feet-Average Depth:0 Feet Length;0 Feet Width:I Calculate ]1 0 Feet Average Depth:0 Feet Total Cubic Yards:0 Length:0 Feet Width:0 FeetWidth: I Calculate]; t. -00 Feet Total Cubic Yards:Average Depth:I Calculata | Walk-Out Basement Project O^Feet Total Cubic Yards:0 Feet Average Depth:0OFeet Width:Length: I Cflieulata I Area to be filled/Leveled 0 Feet Total Cubic Yards: •OFeet0 Feet Average Depth;0 Length:OFeet Width:Length:.1. I C^eulatfl] Length: '0 Feet 0 Feet0 Feel Total Cubic Yards;0 Width:0 Feet Average Depth:Width: [caleulatd] 0 Feet Total Cubic Yards:0Average Depth:- I Calculate I Backfill at Foundation 6VFeet Backfill Total:14 Feet Average Depth:22 Feet Average Width:Linear Length:I Catculaiel Culvert and Road Authority Culvert?No N/ARoad Authority Approval: Impervious Surface - Buildings s Dwelling Proposed: Attached Garage Proposed: Detached Garage Prop'osed: Storage Shed Proposed: 168 Square Feet 0 Square Feet 0 Square Feet 0 Square Feel 0 Square Feet 5846 Square Feel 0 Square Feet 2860 Square Feet 877 Square Feet 0 Square Feet Dwelling Existing; Attached Garage Existing; Detached Garage Existing; Storage Shed Existing: Water Oriented Accessory Structure Existing; Recreational Camping Unit Existing: Miscellaneous Existing: Water Oriented Accessory Structure Proposed: Recreational Camping Unit Proposed: Miscellaneous Proposed; Total Building Proposed Impervious: 0 Square Feel9820 Square Feet •i. 0 Square Feet 168 Square Feet 820 Square Feet Total Building Existing Impervious: 20223 Square Feet| Calculflta | Impervious Surface Calculation - Buildings Total Building Existing Impervious: 20223 Square Feet Total Building Proposed Impervious: i Total Building Impervious Surface: 20391 Square Feet right 188223 Square Feet 168 Square Feet Lot Area: 0.1083Impervious Surface Ratio; Buildings Impervious Surface Percentage: 10.83% "2/4:: ,https://onegov.co.ottertail.mn.us/view.php?id=13866#outer_wrapper ■ vf . • Land & Resource Permit Applications10/8/2020 Impervious Surface - Other 0 Square FeetDeck{s) Proposed; Palio{s) Proposed; 8779 Square FeetDeck(s) Existing; Patio{s) Existing: Sidewalk(s) Existing; 0 Square Feet0 Square Feet 0 Square FeetSidewalk(s) Proposed: Landing(s) Proposed: Driveway(s) Proposed: Parking Area(s) Proposed: 1780 Square Feet 0 Square Feet30 Square FeetLanding(s) Existing; 0 Square FeetDriveway(s) Existing: Parking Area(s) Existing: 18178 Square Feet 0 Square Feet0 Square Feet 0 Square FeetRetaining Wall(s) Proposed:0 Square FeetRetaining Wall(s) Existing: Landscaping Existing: Miscellaneous Existing: 0 Square FeetLandscaping Proposed: Miscellaneous Proposed: 0 Square Feel 0 Square Feet0 Square Feet 0 Square FeetOther Proposed Total:28767 Square FeetOther Existing Total: Impervious Surface Calculation - Buildings & Other 48990 Square FeetTotal Building + Other Existing Impervious: Total Building + Other Proposed 168 Square Feet Impervious: Total Building + Other Impervious 49158 Square Feet Surface: Lot Area:188223 Square Feet Building + Other Impervious Surface Ratio; 0.2612 26.12%Building + Other Impervious Surface Percentage; Shore Impact Zone Impervious 0 Square FeetBuilding(s} Existing:0 Square Feet Building(s) Proposed: Deck(s) Proposed: Patio(s) Proposed: Sidewalks(s) Proposed: Landing(s) Proposed: Driveway(s) Proposed: Parking Area(s) Proposed: Retaining Wall(s) Proposed: Landscaping Proposed: 0 Square Feet420 Square FeetDeck(s) Existing: 0 Square FeetPatio{s) Existing: Sidewalk(s) Exisiting: Landing(s) Existing; Dnveway(s) Existing: Parking Area(s) Existing: Retaining Wall{s) Existing: 0 Square Feet 0 Square Feet0 Square Feet 0 Square Feet 0 Square Feet 0 Square Feet 600 Square Feet 0 Square Feet0 Square Feet 0 Square Feet 0 Square Feet 0 Square Feet Landscaping Existing; Miscellaneous Existing; Total Existing Impervious in the Shore Impact Zone: 0 Square Feet 0 Square Feet0 Square Feet Miscellaneous Proposed: 0 Square Feel1020 Square Feet Total Proposed Impervious in the Shore Impact Zone; 1020 Square Feet | Catcuiat^Total Impen/ious in the Shore Impact Zone: Documentation I:PLEASE NOTE PROPOSED PROJECT AREA MUST BE STAKED 'iv ;I File 1:scale_drawing.pdf Attach Supporting Documentation: Total Proposed Area to Determine 168 Square Feet Fee: Total Earthmoving Request to Determine Fee: 6 Cubic Yards Applicant Approval Applicant Signature:Bladow Jeremy A 09/18/2020Date Signed; Please check to approve;I understand that checking this box constitutes a legal signature Terms MINNESOTA STATUTE 15.99, SUBDIVISION 2 I UNDERSTAND THAT IN ACCORDANCE WITH MINNESOTA STATUTE 15.99, SUBDIVISION 2, OTTER TAIL COUNTY HAS UP TO SIXTY (60) DAYS TO REVIEW AND APPROVE OR DENY THE PERMIT APPLICATION. DURING THE COVID-19 PUBLIC HEALTH EMERGENCY DECLARATION, OR UNTIL DECEMBER 31, 2020, WHICHEVER COMES FIRST, IN ACCORDANCE WITH MINNESOTA STATUTE 15.99, SUBDIVISION 3 (F), OTTER TAIL COUNTY HAS EXTENDED THE REVIEW TIME BY AN ADDITIONAL SIXTY (60) DAYS, AND HAS UP TO ONE-HUNDRED AND TWENTY (120) DAYS TO REVIEW AND APPROVE OR DENY THE PERMIT APPLICATION. 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 THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES https://onegov.co.ottertail.mn.us/view.php?id=13866#outer_wrapper 3/4 10/8/2020 Land & Resource Permit Applications 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. 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 I I understand that it is my responsibility to inform the Land & Resource Management ofnce once the building footings have been constructed. Invoice #9419 (10/04/2020) Charge Cost Quantity Total Site & Lot Permit Fee #1A (0-260 Sq Ft and 0 Cubic yds) added 10 08/2020 9:19 AM $155 Fee $155.00 $155.00X 1 Grand Total Total $155.00 Payment 10/08/2020 $155.00 $0.00Due Approvals Approval Signature Sheila Dahl - 10/05/2020 9:25 AM 627298461b!700648eecb6027e9667f6 72738cccd84f9d668606bc3af6c9ebd6 #1 Received and Assigned Kyle Westerqard - 10/08/2020 2:09 PM 9f7da494649ebe4ed63c91fa9dlfl997 c5306fdcddd3dl25abf9a414d2d9balb #2 Permit Review Kyle Westerqard - 10/08/2020 2:09 PM9d930595a0bd66848e0abe936e7bl8f36370cb68829accbae708c50d51385758 #3 Permit Review Kyle Westerqard - 10/08/2020 2:09 PM 0cb96796020e75c01a6578694bf28251 537187cl617d3a99ddaa663e914dl8al #4 Permit Issuance ^ublic Notes Text:; File(s):[] Internal Notes Text:!’ File(s):t 3 Print View https://onegov.co.ottertail.mn.us/view.php?id=13866#outer_wrapper 4/4 ■„ iI SCALE DRAWING FORM !;\I t K % •^r^oo^l30 \'b^oooTax Parcel Number(s)i The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/or proposed structures, septic tanks, drainfieids, iotlines, road right-of-ways, easements, OHWLs, wells, wetlands and topographic features (i.e. bluffs). Must also complete the Impervious Surface Calculation (see back). /■ 5 i : I i ( I ' I i!; 36OIBO0 • Victor Lundeen'Co, Prinieis • Fergus Pals. • l*300-346-487077;i^BK 042016 SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations T.I60/ IZ'^ I'f 2o ^2^'! 13Structure Set Back from Ordinary High Water Level (Z-(P Ft.Ft. Structure Set Back from Top of Bluff Ft.Ft. ~^o<2 r-Structure Set Back from Road Right of Way Ft.Ft. znStructure Set Back from Lot Lines Ft. &Ft.Ft.&Ft. /5/ VStructure Height Ft.Ft. SStructure Set Back from Septic Tank Ft.Ft. ZO a -f-Structure Set Back from Drainfield Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level 3 3Ft.Ft. Land Slope at Building Site %% \ryCt<^Inspector’s Comments / Sketch: j^— [i'*' O'l 0 aa 5^S'00 o'1 I ^ / ■ Vv. DF / -f EC" is V \ f(Inspector's Signature 12/I Date of Inspection Time of Inspection ccfProject Approved Date / initial APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 WHITE - Office GOLDENROD - Inspector YELLOW - Owner Pink - Assessor l+ooK 1(1^ H SucM'/W97Permit No.LEGAL DESCRIPTION BLUFF ZONEAND SoUoi I ^ frL 3+y ^ LAKE/RIVER I : TO ^3 /3 n YESLOCATION 10 TWP NA^ , ,yros/lTWP NO.RANGESECTIONLAKE NUMBER LAKE/RIVER NAME 3?c TOPOGRAPHICAL ALTERATION □ YES ^NO FIRE NUMBERPARCEL NUMBER (S) f) 3-cnx;- 7.3-0/ 3 2-<jOv tl OF CUBIC YARDS TELEPHONE NO.IDENTIFICATION: Please Print All Information Mailing Address — No. Slr^l, City, State, and Zip Code (Daytime)FirstLast fjame__________________ liooK LiJ^ InitialXoXr ^o7Property Owner I' OHeF-fo i, (A) .S7^o7/ tNameContractor State Lie. # ONSITE SEWAGE TREATMENT SYST^^, ONSITE WATER SUPPLY f> lOi-H ^ PROPOSED USEPROPOSED PROJECT ( ( ) Public ( ) Non Individual( ) New Structure(s)piling ^^^J^il^ddition(s) ■f'Q H ^ ^ Non-Dvnelling /l£,VU,\< ^ ) Water OrienteJ^S&^sory Structure Individual Permit # 5 ) Collector Permit # ( )OTLSD ( )MH/RV cWw\.v CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING CHARACT^ISTJCS OF NON-DWELL|NG C-K ^ ( ) Screen Porch(\ Utility Structure ( ) Boathouse( ) Dwelling (/fT^Udition to Dwelling ( ) Basement /"^n. ( ) Walkout ^aSement Outside Dimension 1/'( ) Gazebo ( \Utility Structure( ) Other Outside Dimension ( ) Other . Outside Dimension Ft. X%OFt. X .Ft.Lotline Setbacks .Ft.-Ft.X 3^2 SO „Lotline Setbacks Ft.&OHWL Setback Ft. Lotline Setbacks OHWL Setback Bathroom:( )No J (lf>e^7 a complying Sewage System Required) 'esTX Ft.OHWL Setback—TrVO Total Bedrooms Maximum Heig^ / 3^t^2 storY iximum Height /10 ft. (1 story)Ft.Mairfmum Height Impervious Surface RatioImpervious Su . Ft.Lot Area S.57)Ft. (3' minimum)Ft. Elevation of lowest floor above OHWLWater Frontage :?.x>Ft. Slope of lot .%Structure setback to right-of-way m Ft. (10'minimum) (Sewage System Permit required before installation).Structure setback to septic tank Ft. (20'minimum) (Sewage System Permit required before installation).Dwelling setback to Soil Absorption System Ft. (10’minimum) (Sewage System Permit required before installation).Non dwelling setback to Soil Absorption System 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Offer 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 Management office once the building footings have been constructed. Dated: Signature of Owner Dated: Land & Resource Management Ofiici01soPERMIT FEE $RECEIPT NO. ^7^Comments: L.etA;i!> ^(rxnJ-\ix3. Form No. BK — 0597-002 •-aOO-3-:6 •;87(286.t'O • V.ciCi'u-.TJeen Co. Printers • Fergus Fd 'S I.1N • r X PL K APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE-Office GOLDENROD - Inspector YELLOW-Owner PINK - Assessor Hook Lii^ I &L Sf */ LEGAL DESCRIPTION BLUFF ZONEAND □ YES ^-NOLOCATION TWP NO.RANGE TWP NAME , ,SECTIONLAKE/RIVERLAKE/RIVER NAMELAKE NUMBERMi /? c•2-2I ■ ?D V/-i/JI\/ FIRE NUMBERTOPOGRAPHICAL ALTERATION □ YES PARCEL NUMBER (S) 7.3-0/32^007)■7 # OF CUBIC YARDS 1 TELEPHONE NO.IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City, Slate, and Zip Code (Daytime)First InitialLast Name HoO^ LiKg-Property Owner A) OXr-57/t /NameContractor State Lie. # ONSITE SEWAGE TREATMENT SYSTEM^^ ' Individual Permit # ■ .) ONSITE WATER SUPPLYPROPOSED PROJECT PROPOSED USE ) Dwelling ( ) Non-Dwelling /-I Individual( ) New Structure(s) 3^jt-) Addition(s) TO ( )MH/RV ) Water OrientedTSSb -- - -- /( ) Public I3( ) Collector Permit # )OTLSD isory Structure (WOAS)3 characteristics OF NON-DWELLING ( ) Garage RISTICS OF WOASCHARACCHARACTERISTICS OF DWELLING VA G|4> YwcKA^ ( ) Screen Porch( M Utility Structure ( ) Boathouse( ) Dwelling Tt?i' Addilion to Dwelling ( ) Basement — ( ) Walkout ^ps^ent Outside Dimension /•.l: ( ) Gazebo (\Utility Structure( )Oth!I [side ( ) Other Outside Dimension Dimension r^t .Ft.'/Ft. X yLotline Setbacks/Ft. FI Y S 0 FILotline Setbacks OHWL Setback Lotline Setbacks fN Ft. OHWL Setback .Ft.Bathroom: Maximum Helgti^^^^(2^storyj3 .Ft.OHWL Setback/ a complying Sewage System Required)Total Bedrooms Maxfmum Height iximum Height /10 ft. (1 story)Ft. '-1WImpervious SuiWe I. Ft. Impervious Surface Ratio .%Lot Area Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage Ft. Slope of lot .%Structure setback to right-of-way m Ft. (10’minimum) (Sewage System Permit required before installation).Structure setback to septic tank Ft. (20’minimum) (Sewage System Permit required before installation).Dwelling setback to Soil Absorption System Non dwelling setback to Soil Absorption System Ft. (10’minimum) (Sewage System Permit required before installation). 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance 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 Management office once the building footings have been constructed. 7/Dated: Signature of Owner M(J3/P7Dated: Land & Resource Mana^emanf5(f-/3i^Pirj9 iRECEIPT NO.PERMIT FEE $ Commenis: U>\i ) . o'3 W /'t Form No. BK — 0597-002 286.110 • ViCtO' t-hjeeh Co. Printers • Fergus Fa >5 MN * ‘ •300 3'16-487( \ INSPECTION RESULTS Make all measurements and computations m Ft.Structure Set Back from Ordinary High Water Level Ft. M10 Ft.Structure set Back from Top of Bluff Ft. az2 Ft.Ft.Structure Set Back from Road Right of Way W m.Ft.Ft.Ft.&Structure set Back from Lot Lines Ft.& 11 Ft.Ft.Structure Height • a Lei J*- fijAn^ Zflf/V IJ2 Ft.Structure Set Back from Septic Tank Structure Set Back from Absorption System Ft. SElevation Of Lowest Floor Above Ordinary High Water Level____________________Ft.Ft. %%Land Slope at Building Line :: 5 Inspector’s Comments / Sketch: UV-* 1 PftV£0 1 J■ I I/ iI■i\ I .1/ \ Date of Inspection Time of Inspection■ I If I! i ^r. •!i-A k« It■■■p'Sii5.std e XIS :n ZfI^AP=:is prg L.i ^ - 3/4 0 4-4 i Wt?(; ■«j I ''■____ -J •',; - rZ^j w- -■ :31 <L I “■;h--•>\ I t T ,1>\ rs■ I I r/! X/ . k•rP f i-i.' • —2r~: I -1 'I I4>iI_3«ciI^fid 3|9«e<1* 0nO£(/'j :n,p--t I- ->ar-r;J\ I .z...o1z JJ flSH-‘f p-r.-t- y,sfc e0 i6fy .-(^4^_j_4 iI:I !;-.1 4- -t I tI I!i 4 f-' Si=w7fc\>1i :I GRID PLOT PLAN feet SKETCHING FORMI.grid(s) equals ^ feet, orScale:jnch(es) equals . 19 s7—^9 Dated; Signature Please sketch your lot indicating setbacks from road right-of-way, lake, sideyard and septic tank and drain- field for each building currently on lot and any proposed structures. Lj CL. 7-/ y t/ )o' C? Pv H TevHi.FC_ t PN «■> % MKL — 0871 — 029 201-949 • Vidor Lundeen Co. Printers • Fergus Falls. MN ■ 1-000-346-4870 >• WHITE-Omce GOLDENROD - Inspector YELLOW - Owner PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS. MN 56537 t'Hook LtiM Permit No.LEGAL DESCRIPTION cBLUFF ZONEAND 6-L □ YESLOCATION <v. LAKE NUMBER. - - . LAKE/RIVER NAME LAKE/RIVER SECTION TWP NO. RANGE TWP NAME . ,yws/i L-€>^^2 V/-PARCEL NUMBER (S)63-cw- 7,3-o/3g-ool)TOPOGRAPHICAL ALTERATION □ YES J^NO FIRE NUMBER ‘0^« OF CUBIC YARDS IDENTIFICATION: Please Print All Information TELEPHONE NO. St Name__________________First ^ In^ialiroOK Ll{\JL Xc'ci-vr Mailing Address — No. Str^t, City, Stale, and Zip Code (Daytime) fellProperty Owner a)-t state Lie. # I NameContractor PROPOSED PROJECT PROPOSED USE ONSITE WATER SUPPLY ONSITE SEWAGE TREATMENT SYSTEM/-oL' ( ) Non-Dwelling (( ) Public ( ) None ( ) New Structure(s)elling Individual 6^^ddilion(s) -f-Q M ^£.t^Ci« ^ ) Water Orientetf^Ajh f ( ) Collector Permit # ( )OTLSD Individual Permit H ( }MH/RV fSory Structure CHARACTERISTICS OF DWELLIN CHARACTERISTICS OF NON-DWELLING CHARACTERISTICS OFWOAS ( ) Dwelling ■jTi™ ( ) Basement ( ) Walkout Basement Outside O Dimension / (\ Utility Structure ( ) Boathouse ( ) Screen Porch dition to Dwelling ( ) Gazebo ( \utility Structure( ) Other Outside Dimension .Ft.( ) Other. Outside Dimension/OFt. X Lotline Setbacks .Ft. A'X Lolline Setbacks OHWL Setback Lolline Setbacks OHWL Setback .FI Bathroom:( )No J a complying Sewage System Required) (I'es OHWL SetbickTotal Bedrooms Maximum Heig Maximum Height Ft..iximum Height /10 ft. (1 story) Lot Area Impervious Su |, Ft.Impervious Surlace Ratio'b.SDWater Frontage Structure setback to right-of-way. ,Ft. Elevation of lowest floor above OHWL Ft. (3' minimum) .Ft. Slope of lot mStructure setback to septic tank Ft. (10’minimum) (Sewage System Permit required before installation). Dwelling setback to Soil Absorption System ___ Non dwelling setback to Soil Absorption System Ft. (20'minimum) (Sewage System Permit required before Installation). Ft, (10'minimum) (Sewage System Permit required before installation), THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: 1 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. 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 expres* condition that the person to whom it is granted, and his agent, employees and workmen shall conform In all respects to the Ordinance 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 Management office once the building footings have been constructed. Dated: Sign3tuf0 of Owner Dated; Land A Resource Management OfficeQZ-SOPERMIT FEE $RECEIPT NO. ^ Lot / Le{Aji% ^ (V- 5rrf- Comments: (,1. r^.\ Form No. BK — 0597-002 786 ’10 •.-J-FT I'.c P.r ., .• '070 3-6 ;e'i tl yiUJ-4-^ p{£n^l \ i \aj^ (JYX GRID PLOT PLAN feet SKETCHING FORMScale:,grid(s) equals .feet, or..inch(es) equals .# Dated:19 Signature Please sketch your lot indicating setbacks from road right-of-way, lake, sideyard and septic tank and drain- field for each building currently on lot and any proposed structures. / /// 10 ' O Pv l'\^ 3-V' 'ifj MKL — 0871 — 029 2SI949 • Victor luncteen Co. Ponteri • Fergus Fall* MN • 1-U0t>340-4670