HomeMy WebLinkAboutChaffee_02000990360000_Shoreland Permits_SHORELAND MANAGEMENT
OTTER TAIL COUNTY
FERGUS FALLS, MINN.
MKL-0871-030 I | |
NortVvUw /O ~ /fFile Opening DateL
Individual FHe T* )
Name of
Applicant;_____
Legal
Special Use ( )Use Description.Subdivision File ( )Subdivision ne____
rt Address:7 Zip No.Phone No.City StateLast Name First
Lake Or River Name
St. 8i No.
/s/ 4/0
Sec. Twp. Range
cQ-ccc -"^9-c 369-COO
o3i^ oco C360-O00
^ /Tiay^
Classif.Twp NameLake No.
p-S' L;_^ r^La
.^JUXL,!y 8 9-^*9 UfiTTOA)Acts
O BUILDING PERMITS VARIANCES ON RUILDING PFRMITR
Date NotifiedHearing JudgementHearing DateDate Inspected ResultsPurpose Appl. DateDateML.
3-3-^5'
l/Lc>U-7-75 CtiyvA .
it/Z-^5g%Ti 2 N
0 SEWAGE SYSTEM PERMITS VARIANCES ON SEWAGE SYSTEM PERMITS
Hearing JudgementHearing DateResultsAppl. Date Date NotifiedDate InspectedPurposeDateNO.
•f-R 73Amd/ms vS»SUL€7^
u' 1--:^■ClLv^ -
B SPECIAL USE PERMITS
COMMENTS SECTION;Notice MailedHearing DateApplication Date
Csq::; cup^ 3Hn
/ly\W
m
WHITE - Office
GOLDENROD - Inspector
YELLOW - Owner (after issue)
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.usOTTCR TAIl
APPLICATION MU$T BE COMPLETED ORDER Hjreg^^fioCESSED.
couRTY-aitai O T N
Permit No.
>^KE/RIVERNAME /WKE/RIVER /SECTION TWP NO. RANGE, ^ TWP NAME.^—LAKE / RIVER NO.
PA^CE^NU^RtS^^^^
"f9o^
PROPERTY (E-911) ADDRE^^^-^
^'cXt h A//^ 57^
LEGAL DESCRIPTION _
sv-T/r.l^ot i-/Q - M 7Tc2.H
DEVELOPED
UNDEVELOPED
Last Name First Initial Mailing Address Daytime Phone No.
A'Ue^Property
Owner
C'^-^ 1> A-H ci
7 .5^3b/Z7 _______
A//y S~77
Contractor
Name ^
Lie.#
A. do
__i <3 ^
PROPOSED PROJECT (please circle the appropriate number)
(1 ) New Dwelling
(4) MHA-R____
( 7) Add’n To Non-Dwelling T§TStorage StructurO
(10 ) Non-Conf. Replacement (identify}"
(11) Other (identify)________________________
(12 ) Deck________________________________
(13 ) Fence_______________________________
ONSITE WATEfkSUPPLY
(?flndividual (^^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.
( ) Compliance Inspection Report within 3 yrs.
i (Attached)
f^) OTWMD 'Must have Salvage System Approval
from OTWMD prior to issuing Site Permit.
Contact Roltie Mann at 218-864-5533
( ) New Septic Permit Issued
Permit It
( 2 ) Add’n to Dwelling/Attached Garage (3) Replacement Dwelling’
(6) Detached Garage
(9) W.O.A.S.
(5) RCUA'ear.
l/vay-err rpfs
"Existing Non-Conf. Structure Verified by L&R■Removal of Existing Dwelling Verified by L&R
Inspector's Initial/Date Inspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED DWELLING CHARACTERISTICS OF PROPOSED NON^WELLING (Must Include Attached Garage) Outside / \y^
Outside DimensionFt. xFt." Dimension —Z_^^/Rf'x —7^— Ft.
Sq. Ft. --------- Sq. Ft. ^ ^ ^
Setback to Lotline ----------------Ft. &-----------------Ft." ggtback to Lotline ZM777L &
Setback to Right of Way ----------------Ft." g^.Z4^"
Setback to Ordinary High Water LevqL^Ft.
Elevation Above Ordinary High \^er LevelFt. ' ^ ^ TySetback to Septic Tank \ Elevation Above Ordinary High Wate^evelJT \7 Ft.
Setback to Drainfield 9 Setback to Septic Tank 70C^x._
Setback to Bluff_________ Setback to Drainfield
Total Bedrooms^.^1--------- Setback to Bluff \jfC
Maximum Pjjd^sed Height _ Maximum Proposed Heioht /y Ftl V j
Roof Change ( ) Yes ( ) NoBasemen! ^ ) Yes ( ) No Change ( ) Yes
Walkout Basement ( ) Yes (side profile required) ( ) No Proposed ( ) Yes ty )
Ft. X F>"
Sq.Ft.
Setback to Lotline ___
Setback to Right of Way
Setback to Ordin^ryJ^gh Water Level __
Elevation Above OrdinaTy-High Water Level
Setback to Septic Tank
Setback to Drainfield^
Setback to Bluff /
Ft.&Ft."
Ft."
Ft.
Ft.
Ft.
Ft.
Ft.
Maximum Proposed Height
( ) Boatfic
( ) Gazebo
Ft.(7^)NQj//
( ) Screen Porch
( ) Storage Structure
N«f^ouse
Topographipal Alteration / Earthmovin
20 Cubic Yards or Lge^ *
* Must include on scale drawing,
additional Permit may be required.□ 21 Cubic Yards - 999 Cubic Yards*□ None □ 1,000 Cubic Yards or More*
CHARACTERISTICS OF LOT:Lot Area Sq. Ft.Water Frontage Ft.Bluff ( ) Yes ( ) No45
'i?.%.%
Building Surface Ratio Impen/ious 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 Management office once the building footings have been constructed.
Date: g/lQ|l'/
Signatur^f Property Owner / Agent for Owner
fimuLand S Resource Management Official
Date:
No L^<00PROJECT(S) TOTAL SQ.FT.,PERMIT FEE $RECEIPT NO.
Date StampComments:
L&R InitialForm No. BK —04-2016 360,647 • Victor Lundoen Co., Printers • Fergus Falls. Minnesota
WHITE-Office
GOLDENROD - Inspector
YELLOW - Owner (after issue) *
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
r
mOTTCR mil
PROCESSED.
counTTBiiaiioTii
Permit No.APPLICATION MUST BE COMPL
LAKBRIVER NAME LAKE/RIVER SECTION TWPNO. RANGE , TWP NAMELAKE / RIVER NO. ,
--t^ j ; /z u/
e r-
3
PROPERTY (E-911) ADDRESS
3-^ h i/^
LEGAL DESCRIPTION
/ :->r //\r? y "Tiiz. H
DEVELOPED
UNDEVELOPED.
Last Name First Initial Mailing Address Daytime Phone No.
Property
Owner
/^ S' Cl FC- Uz. V
_i , r-V<i -Ff do 33/^7 4tl:!Contractor
Name
Lie.#/^/ a-^ ^ k^o^c4___________L
f
ONSITE WATER SUPPLY
(>) Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
PROPOSED PROJECT (please circle the appropriate number)
(1 ) New Dwelling
(4) MHA'R____
(7) Add’n To Non-Dwelling (8 ) Storage Structure^ Iz
(10) Non-Conf. Replacement ('/dent/^j**'I_______
(11) Other (identify)____________________________
(12) Deck___________________________________
(13) Fence___________________________________
ONSITE SEWAGE TREATMENT SYSTEM
( ) L&R Cert, of Compliance within 5 yrs.
( ) Compliance Inspection Report within 3 yrs.
. (Attached)
K/} OTWMD 'Must have Selvage System Approval
from OTWMD prior to issuing Site Permit.
Contact Rollie Mann at 218-864-5533
( ) New Septic Permit Issued
Permit #
(2 ) Add’n to Dwelling/Attached Garage (3) Replacement Dwelling*
(5 ) RCUA'ear________ (6) Detached Garage
(9) W.O.A.S.
•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
Dimension
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
Outside Dimension___
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________
Total Bedrooms
Maximum Proposed Height
Roof Change ( ) Yes ( ) No
Basement ( ) Yes ( ) No
Walkout Basement ( ) Yes (side profile required) ( ) No
CHARACTERISTICS OF PROPOSED NON^DWELLINQ
Outside , ^ '
Dimension x C> RTx Ft." '
Sq. Ft. yyd>
Setback to Lotline
Setback to Right of Way ^ ^>*^Ft.** .
Setback to Ordinary High Water Level
Ft. X Ft.**Ft. X Ft."
f(^D 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
( ) Boathouse
( ) Gazebo
**Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft.&Ft.**
Ft.&Ft."Ft.**
Ft.**Ft.
Ft.Ft.
Elevation Above Ordinary High Water Level
Setback to Septic Tank
Setback to Drainfield
Ft.Ft.
Ft.Ft.
Ft.
Ft.
Setback to Bluff Ft.Ft.
Maximum Proposed Height
)Yes ( )No^
Ft.
Roof Change (
Bathroom Proposed ( ) Yes (,( ) Screen Porch
( ) Storage Structure
)Ner*^
Topographical Alteration / Earthmovin^^
20 Cubic Yards or Less *
* Must Include on scale drawing,
additional Permit may be required.□ None □ 21 Cubic Yards - 999 Cubic Yards*□ 1,000 Cubic Yards or More*
/
CHARACTERISTICS OF LOTr Lot Area.Sq, Ft.Water Frontage Ft. _ Bluff ( )Yes ( )No
>.%.%
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 responsibiiity to inform the Land & Resource Management office once the building footings have been constructed.
Fj/h li'/ ' ■
Signature,6^ Property Owner / Agent for Owner
Date:
/3llQ // 7 /
r .■/i7l(Date:
Land & Resource Management Offidai
I HO PERMIT FEE $ / ’SO • 0 C>PROJECT(S) TOTAL SQ. FT.RECEIPT NO.
Comments:
I^ISSI
Form No. BK — 04-2016 360,647 • Victor Lundoen Co., Printers • Fergus Falls. Minnesota
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
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.
/^lA^Ft.SofStructure Set Back from Lot Lines Ft.&Ft.&Ft.
Structure Height /O —Ft.Ft.
Structure Set Back from Septic Tank Ft.Ft.I O
structure Set Back from Drainfield Ft.Ft.
Elevation Of Lowest Floor Above Ordinary
High Water Level 3 Ft.Ft.
Land Slope at Building Site %%
Inspector’s Comments / Sketch:
LAI^C
■
\
?•>V
li
4
I
I i■r
lp\I |4
r ,1 \
i ^
Inspector’s Signature
C o Hcj Y ///-/u-r'?
Date of Inspection
Time of Inspection
Date / Initial
SCALE DRAWING FORM1
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 and topographic features (i.e. bluffs). Must also complete the
Impervious Surface Calculation (see back).
Scale
I s'K'J
// A
^ J/ /?
#/ //
Pf/ 1
' I
SE'LT R/W LINE OF
C.S.A.H. NO. (
T
EDGE 1-/^ f\ IA K A TJO
I Vi IBIT I \J/ I \l
sti
i/■»>
ilN/>
/ / I J / ">s^.
O’ £«m ^*3 V
KJ /(0 //LS.e:CONCRETE -ORDINARY NIGH HATtR
LINE PER ONIN ELEVATION
OF 1321,3' (m2 DATUtT)
/SURVEY
LINE/oriP*d.' AJ5 t/wED A'/A #
'S}>
A1 Y<e
V\
VS^/■ J //FENCE'f///f/IMPERVIOUS AREA BREAKDOHN:
f// 'NE'LT CABIN
CONCRETE / « SO. FT.
CONCRETE 2 = 36.7 SO. FT
----------^'Lr-CABtbhL
CONCRETE
HOUSE
CONCRETE
PATIO BLOCK « 60.0 SO. FT.
- 13.0 SO. FT.
= 33<^.4 SO. FT.
= 311.2 SO. FT.
«“gmT~S9r^TT.
= 6<12.3 SO. FT.f//A
020 » 152.7 SO. FT.
» 2,4*K.O SO. FT.
- 5<?7.3 SO. FT:lOST N'LY COR.
OF LOT iq/
STEI^
^ GARAGE
NE'LY BIT.
S»‘tTFimT
CURVE E TOTAL - 5,7«.0 SO. FT.
RADIUS ARC LENGTH CHC4?D LENGTH CHORD BEARING DELTA ANGLE
N 26’23'32" E OTSTII'2331.7P 75.11 75.10 ~"i:TP^Pr3nfa^Q.3JiSoCALCJS"0 s. ^
R/N -
. 24.fi;
TOTAL AREA OF CT>EN SPACE =17,43
NOTEt IMPERVIOUS AREA CALCULATU
THE ASSUMPTION OP OTTER TAIL COL
3 Z-s
IMPERVICXIS AOPeti » 2.3
TOTAL AREA EXCLUDING ROAD
IMPERVIOUS AREA =-■N, HOWE & LANGLIE, INC.
SURVEYORS. CIVIL ENGINEERS & LAND DEVELOPMENT CONSULTANTS
MILL STREET. FERGUS FALLS. MN 565384)125 (218) 739-5268
)WAY. SUITE 208. ALEXANDRIA. MN 56308 (320) 762-5263
(800) 300-9276 *1
Id RS&BtXtK^
,2
£/ Signature of Property Owner
IMPERVIOUS SURFACE CALCULATION
List & identify all ej^fsying & ^oposed onsite impervious surfaces on scale drawing.
/ 7Lot Area (ft^):Signature:Date:
Buildings Other impervious Surface
Existing Proposedi-x2 Existing
r-x2 Proposedi-x2FtFt Ft Ft
JT1 o tiff Deck(s)Dwelling
Attached Garage Patio(s)
7.^9. U Sidewalk(s)Detached Garage
Storage Shed Landing(s)
WOAS Driveway(s)^oa.RCU Parking Area(s)
Retaining Wall(s)Miscellaneous
Landscaping
(Plastic Barrier)
^7rr hi
:9-^-------Miscellaneous
5-^'12.
T 0^0% &TOTAL BUILDINGS /f^TOTAL OTHER
Buildings
Impervious Surface
Percentage
Maximum Allowable 20%
Existing
i-x2
Proposed
r-x2
Total Lot Area Impervious
Surface
Ratio
Ft^Ft^Total Buildings FtFt
/■;./0111 100+ss.X
Buildings + Other
Impervious Surface
Percentage
Maximum Allowable 25%
Total
Buildings + Other
Impervious Surface
Existing
i-x2
Proposed Total Lot Area Impervious
Surface
Ratio
Ft^Ft^ Ft^Ft
5 100+-r x
Impervious Surface Calculation Worksheet 03-25-2014
OTTER TAEL WATER
MANAGEMENT DISTRICT
27234 368THAVE.
Battle Lake, MN 56515
Phone (218) 864-5533
Mr. John Gunderson
33177 Otter Tail River N
Ottertail, MN 56571
This letter is in reference to the septic system at 39590 Co Hwy #1 P/N02000990360000 owned by Orion
Chaffee . That system is connected to a central commimity drain field system. At the present time it is
functioning properly. The District has no objection to the installation of a storage shed. All wells are the
owners responsibility.
If you have any questions please feel fiae to contact me. Thank You
Roland R Mann
Administrator
SCALE DRAWING FORM
b f ^ cot)
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 and topographic features (i.e. bluffs). Must also complete the
Impervious Surface Calculation (see back).
Scale
/
i/iH"
T (j/
/
O' /
ORDINARY NION NATtR
LINE PER ONhl ELEVATION
OF 1321.3' CI9I2 DATun)
IMPERVIOUS AREA BREAKDOHN:
= SO. FT.NE'LY CABIN
CONCRETE I - SO. FT.aiM CONCRETE 2 • 36.7 SO. FT
—SH'L r CABIN-m.SOB:2-SO~H=^r~
*= 152.7 SO. FT.CONCRETE
= 2,4^.0 SO. FT.HOUSE
* 5<^7.& SO. FT.CONCRETE
PATIO BLOCK ~ 60.0 SO. FT.
- \&.0 SO. FTSTE!^
» 33P.4 SO. FT.^ GARAGE
= 3H.2 so. FT.u^NE'LY BIT.
^~FT.
TOTAL - 5,762.0 SO. FT.
ARC LENGTH CHORD LENGTH CHORD BEARING DELTA ANGLERADIUS
or3i'ii‘‘N 26’23'32* E2331. ?<?75.11 75.10
IMPERVIOUS ARtA CALC
OPeys QFes s 2.3 5. p
TOTAL AREA EXCLUDING ROAD R/N .
inPERVIOUS AREA 24.3i
TOTAL AREA OF OPEN SPACE = I7,43t
NOTEr IITPERVIOUS AREA CALCULATE
THE ASSUtIPTICN OF OTTER TAIL COL
N, HOWE & LANGLIE, INC.
JURVEYORS. CIVIL ENGINEERS & LAND DEVELOPMENT CONSULTANTS
MILL STREET. FERGUS FALLS. MN 56538-0125 Q18) 739-5268
)WAY, SUITE 208, ALEXANDRIA. MN 56308 (320) 762-5263
(800) 300-9276 -
Signature of Property Owner
IMPERVIOUS SURFACE CALCULATION
List & identify all eWsiing & iVoposed onsite impervious surfaces on scale drawing.
/ 7
Lot Area (ft^):Signature:Date:
Buildings Other Impervious Surface
Existing Proposed Existing
r-1.2
Proposed
Ft^ Ft^Ft^Ft
Q'XlO.UDwelling Deck(s)
Attached Garage Patio(s)
J'^9. UDetached Garage Sidewalk(s)
storage Shed Landing(s)
WOAS Driveway(s)
RCU Parking Area(s)
Miscellaneous Retaining Wall(s)
Landscaping
(Plastic Barrier)
c.a/’/z-x Miscellaneous
TOTAL BUILDINGS TOTAL OTHER
Buildings
Impervious Surface
Percentage
Maximum Allowable 20%
Existing
i-x2
Proposed Total Lot Area Impervious
Surface
Ratio
Ft^Ft^Ft^Total Buildings Ft
m-1l^'i 0-111 100+X
Buildings + Other
Impervious Surface
Percentage
Maximum Allowable 25%
Total
Buildings + Other
Impervious Surface
Existing
r-i2
Proposed
i-i2 Total Lot Area Impervious
Surface
Ratio
Ft^Ft^Ft Ft
0'%5 100+X
Impervious Surface Calculation Worksheet 03-25-2014
I
OTTER TAIL WATER
MANAGEMENT DISTRICT
27234 368TH AVE.
Battle Lake, MN 56515
Phone (218) 864-5533
Mr. John Gunderson
33177 Otter Tail River N
Ottertail, MN 56571
This letter is in reference to the septic system at 39590 Co Hwy #1 P/N02000990360000 owned by Orion
Chaffee . That system is connected to a central commimity drain field system. At the present time it is
functioning properly. The District has no objection to the installation of a storage shed. All wells are the
owners responsibility.
If you have any questions please feel Iree to contact me. Thank You
Roland R. Mann
Administrator
r
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
WHITE - Office
GOLDENROD - Inspector
YELLOW - Owner (after issue)
OTTER TfllleoiiTT-aiiiiioTi
Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.
LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER SECTION TWPNO.RANGE TWP NAME
/■Z- ysy \ /ir/Wfl.
PARCEL NUMBER (S) ^
O -Z Cp
PROPERTY (E-911) ADDRESS
rLEGAL DESCRIPTION DEVELOPED
UNDEVELOPED_____
Last Name First Initial Mailing Address Daytime Phone No.
Property
Owner
<5"5"/^5
9^
2-3/77
T^rOerr 7fo:3,c/ _____________
M// *^^7/ 7
^Contractor
Name
Lie.*
3 S>'^~2C'>'Z.
PROPOSED PROJECT (please circle the appropriate number)
(1 ) New Dwelling
(4 ) MH/YR____ _____
(7) Add'n To Non-Dwelling ^) Storage Structure
(10) Non-Conf. Replacement (identily)"
(11) Other (identify)____________________
(12) Deck__________________________
(13) Fence_________________________
ONSITE WATER SUPPLY
()^’lndividual ( ) 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.
( ) Compliance Inspection Report within 3 yrs. (Attached)
(V) OTWMD 'Must have Sewage System Approval
from OTWMD prior to issuing Site f^rmit.
Contact Rollie Mann at 2W-864-S5f3UkfUkr
( 2 ) Add'n to Dwelling/Attached Garage (3) Replacement Dwelling'
(5) RCU/Year.(6 ) Detached Garage
(9) W.O.A.S.\ML>
{ ) Undeveloped Lot
'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)I^^OFp^^D NON-DVI^CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
OutsidesDimension
Sq. Ft. \
Setback to Lotltne
Setback to Right ohi^y _____
Setback to Ordinary W^Watprlevel __
Elevation Above Ordinary'^h Water Level
Setback to Septic TankX
Setback to Draintieig
Setback to Bluft/_____
Total Bedrogpfs_______
Maximurn/roposed Height
Roof GMange ( ) Yes ( ) No
Bas^ent ( ) Yes ( ) No
Walkout Basement ( ) Yes (side profile required) ( ) No
CHARACTER
Outside
Dimension
ING
Outside
DimensiiFt. x Ft."Ft. x «*
Sq. Ft. / nm
Setback to Lotline
Setback to Right of Way V O
Setback to Ordinary High Water Level ____
Elevation Above Ordinary High Water Level 3
Setback to Septic Tank IflD Ft.!"^ i
Sq. Ft. \
Setback to Lotline \
^^ "Setback to Right of Way
^back to Ordinary^
Elevation Above Ordinary High Wat
Setback to Seotfc Tank
IFt.&Ft."Ft."[&Ft.”^ Ft."
Ft."Ft.
Ft.WaidNlevel Ft.
FI..evel Ft.
Ft.Ft.Setback to Drainfield
Setback to Bluff__,
Maximum Proposed Height /
Setback to 0rainfield___
Setback/o Bluff_______
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
**Pro|ect/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft.
Ft.Ft.
Ft.
Roof Change ( ) Yes (y) No .
Bathroom Proposed ( )Yes (^) No ( ) Screen Porch
( ) Storage Structure
Topographical Alteration / Earthmoving
□ 21 Cubic Yards - 999 Cubic Yards'
' Must include on scale drawing,
additional Permit may be required.20 Cubic Yards or Less '□ None □ 1,000 Cubic Yards or More'
/;TV- 2 4:. R
2.5,
CHARACTERISTICS OF LOT:Bluff ( )Yes (>C)NoLot Area. Sq. Ft.Water Frontage
10.1 7o .%.%
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, l^nnesota. 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 v^ for a period of six (6) months.
Permit; Permission is hereby granted to the above named applicant tdoerform the work d^|«ibed in the above statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees rfib workmen shg)l^0(nform in all respects to the Ordinances of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of said Ordinipfcas.
I understand that it is my responsibiiity to inform the Land Allesource Man nirnentoffic^ice the buiiding footings have been constructed.
4/Date:
Sigi of Moperty Ovmer / Agent for Owner
Date:
^Land & Resource Management Official
150-00mPR0JECT(S) TOTAL SQ. FT.,PERMIT FEE $RECEIPT NO.
Date StampComments:
/
L&R InitialliteaForm No. BK — 04-2014 . 354,252 • Victor Lundeen Co., Printers ■ Fergus Falls, Minnesota
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
WHITE - Office
GOLDENROD - Inspector
YELLOW - Owner (after issue)
OTTCRTIIIl
APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.
eofiTr-aiiiiiioTi
Permit No.
LAKE / RIVER NO.
.»J i'' *■ /
LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWPNO.RANGE TWP NAME
r-t:\
o 2.
PROPERTY (E-911) ADDRESS
LEGAL DESCRIPTION / JL T~U^P ^ ZZ h P/
DEVELOPED /K
UNDEVELOPED.
;First Initial Mailing Address Daytime Phone No.Last Name
C. lOrisoi VProperty
Owner Aj A/ *S~/ ^ SyAf [id-!<
K / 03.^
‘ 01-^
■/ <^^/7 J APS i tContractor
Name
Lie.#
C ;fySS''
"tlf’/AirV' 1^^7/ i' 6T2./'
PROPOSED PROJECT (please circle the appropriate number)
( 2 ) Add'n to Dwelling/Attached Garage (3) Replacement Dwelling*
(6) Detached Garage
(9) W.O.A.S.
ONSITE WATER SUPPLY
0() 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.
( ) Compliance Inspection Report within 3 yrs. (Attached)
(Y) OTWMD ‘Must have Sewage System Approval
from OTWMD prior to issuing Site Permit.
Contact Roiiie Mann at 218-8S4-5533
( ) Undeveloped Lot i_ ('i I i'i I ' i,
(1 ) New Dwelling
(4) MH/YR____(5)flCU/Year_____
(7) Add’n To Non-Dwelling \ {8 ) Storage Str^ctqfe Ji 1 j ^
(10) Non-Conf. Replacement (identify)"_______) 7, /■.iv.,0
(11) Other (identify)_____________________________
(12 ) Deck___________________________________
(13) Fence_________________________________
if
^Removal of Existing Dweiling 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
Dimension
CHARACTERISTICS OF PROPOSED DWELLI^IG
(Must Include Attached Garage)
Outside-Oimension
Sq. Ft.
Setback to Lotiine ___
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary Higfi Water Level
Setback to Septic Tank'__
Setback to DrainfieM___
Setback to Bluff_______
Total Bedroqrhs_______
Maximum Proposed Height
Roof Change ( ) Yes ( ) No
Basement ( ) Yes ( ) No
Walkout Basement ( ) Yes (side profile required) ( ) No
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension
1/■
/iPA/F1.X -•Ft."Ft. X Ft."A"Ft. XSq.Ft.':^^^^ ^,
Setback to Lotline A ^ ^ (J
/
f Sq. Ft.
Setback to Lotline \
Ft.i..,Ft."Ft.**yPt.&Ft.**Ft."Ft.Setback to Right of Way
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level .. 3
Setback to Right of Way _____
.^Iback to Ordinary High Wat^ Level
Elevation Above Ordinary High Waterlevel
Ft.\
Ft.**-75Ft.
Ft.Ft.
Ft>'v Ft.Ft.
f\Setback to Septic Tank r'e -.Setback to Septic Tank__
Setback to Drainfield____
Setback to Bluff_______
Maximum Proposed Height
Ft.Setback to Drainfield
Setback to Bluff
Maximum Proposed Height A ^
Roof Change ( )Yes
Bathroom Proposed ( ) Yes (X) No
JlUf Ft.
Ft.
Ft.(V) No y ( ) Boathouse
( ) Gazebo
( ) Screen Porch
( ) Storage Structure
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
Topographical Alteration / Earthmoving L.' * v'’’- -t ' ’
□ None
* Must include on scale drawing,
additional Permit may be required.2i 20 Cubic Yards or Less *□ 21 Cubic Yards - 999 Cubic Yards*□ 1,000 Cubic Yards or More*
^ Ft,Bluff ( )Yes (<*<‘)NoCHARACTERISTICS OF LOT:Sq. Ft.Lot Area.Water Frontage i
I
/..%,%
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 Management office once the building footings have been constructed.
Date:
Signature of Property Owner/Agent for OwneriL-;■ j ADate:
PROJECT(S) TOTAL SQ.FT.
\Land & Resource Management Official
i/O-AO r^ni)PERMITTEES RECEIPT NO.
Comments:
iteaForm No. BK —04-2014 354.252 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
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.
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.
Elevation Of Lowest Floor Above Ordinary
High Water Level Ft. Ft.
Land Slope at Building Site % %
Inspector’s Comments / Sketch:
y
Inspector's Signature
Date of Inspection
^'.OO
Time of Inspection
Date / Initial
•f----------
SCALE DRAWING FORM!>
^ iMOd
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 and topographic features (i.e. bluffs). Must also complete the
Impervious Surface Calculation (see back).
Scale
I
SE'LY R/W LINE OF
C.S.A.H. NO. I
T 0-//
T“/^ N I
I I V
ORDINARY HIGN HATtR
LINE PER ONhl ELEVATION
OF 1321.3' (I<^I2 DATUn)
SURVEY
LINE
IMPERVIOUS AREA BREAKDOWN:
= 30. FT.
CONCRETE I “ 3<1.0 30. FT
CONCRETE 2 - 36.7 SO. FT
SN'LY CABIN
CONCRETE
NE'LY CABIN
m 503.2 SOr- PT-
•= 152.7 50. FT.
= 2,4‘K.O SO. FT.
- 5<^7.d 30. FT.
ZO
HOUSE031 H'LY COR./CONCRETE
RATIO BLOCK * 60.C 50. FT.OF LOT R
- la.O SO FT
- 33^1.4 SO. FT.
= 3H.2 so. FT
- -Ctf .r FT.
STEI^
l\ ^OARAGE
NE'LY BIT.
SM'LY BlTT4^^
CURVE TABLE TOTAL - 5, 762.0 SO. FT.
CHORD LENGTH CHORD BEARING DELTA ANGLERADIUS ARC LENGTH
N 2G‘23'32" E 01’31'II"3.Dso s. /IMPERVIOUS CALC
OPeA s 2-3 Z-‘CO 5. P
TOTAL AREA EXCLUDING ROAD R/hl =
IMPERVIOUS AREA * 24.3%
TOTAL AREA CP OPEN SPACE = !7^43<
NOTE> IMPERVIOUS AREA CALCULATIC
THE ASSUtIPTION OF OTTER TAIL COU
75.102631.7P 75.11
N, HOWE &. LANGLIE, INC.
SURVEYORS. CIVIL ENGINEERS & LAND DEVELOPMENT CONSULTANTS
MILL STREET. FERGUS FALLS. MN 56538-0125 (218) 739-5268
)WAY. SUITE 208. ALEXANDRIA. MN 56308 (320) 762-5263
(800) 300-9276
f / Signature of Property Owner '
!IxrX
Date
BK — 032014 3f4.120 • Victot Lundeen Co. Printers • Fergus Palis. MN • 1-8003A6-407C
IMPERVIOUS SURFACE CALCULATION
List & identify all e)^sjiing & ^oposed onsite impervious surfaces on scale drawing.
/ /Lot Area (ft^):Signature:Date:
Other Impervious SurfaceBuildings
ProposedExistingProposedExisting
Ft^Ft^ Ft^Ft
Q'^X'ln.U Deck(s)Dwelling
Patio(s)Attached Garage
7.^9. iJ Sidewalk(s)Detached Garage
Landing(s)Storage Shed
Driveway(s)WOAS
Parking Area(s)RCU
Retaining Wall(s)Miscellaneous
Landscaping
(Plastic Barrier)
C //7rr. At
n C.&Miscellaneous
-j-=rr 12:
TOTAL OTHERTOTAL BUILDINGS
Buildings
Impervious Surface
Percentage
Maximum Allowable 20%
Impervious
Surface
Ratio
Proposed Total Lot AreaExisting
Ft^Ft^Ft^FtTotal Buildings
n-t0-/’V 100+X=:
Buildings + Other
Impervious Surface
Percentage
Maximum Allowable 25%
Proposed Total Lot Area Impervious
Surface
Ratio
Total
Buildings + Other
Impervious Surface
Existing
Ft^Ft^Ft^Ft o--------
Q.Vb%fill 100'-T-X
Impervious Surface Calculation Worksheet 03-25-2014
OTTER TAIL WATER
MANAGEMENT DISTRICT
27234 368TH AVE.
Battle Lake, MN 56515
Phone (218) 864-5533
Mr. John Gunderson
33177 Otter Tail River N
Ottertail, MN 56571
July 16,2014
This letter is in reference to the septic system at 39590 Co Hwy #1 P/N02000990360000 owned by Orion
Chaffee . That system is connected to a central community drain field system. At the present time it is
functioning properly. The District has no objection to the installation of a storage shed. All wells are the
owners responsibility.
If you have any questions please feel free to contact me. Thank You
Sincerely,
Roland R. Mann
Administrator
WHITE - Office
QOLDENf^OD'- Inspector
YELLQW - 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.PLEASE PRINT OR TYPE ALL INFORMATION
TWP NAMELAKE/RIVER SECTION TWP NO.RANGELAKE / RIVER NO.LAKE/RIVER NAME CLASS
S'S-S^S, d)TT^7^/l- (},P /c'
PROPERTY (E-911) ADDRESS <CPARCEL NUMBER (S)
o o 3'y ^
a a> ^ 'ycoc^a’^c^
S'fCT '-/aLEGAL DESCRIPTION
Daytime Phone No.Mailing AddressFirstInitialLast Name
Property
Owner
Se[.j^Contractor
Name
Lie.#(dJ-/ - 4<f ? -^ 3-r7
PROPOSED PROJECTiplease circle the appropriate number)
(1 ) New Dwelling ([^
(4) MH/YR
( 7 ) Add’n To Non-Dwelling
LUU Non-Conf. Replacery
Ull^ther (identifvi
'Existing Dwelling to be removed prior to
ONSITE WATER SUPPLY
P<5 Individual ( ) Public ( ) None
ONSITE SEWAGE
TREATMENT SYSTEMijef-HLor\dd'n to Dwelling
( 5) RCUA'ear
( 8 ) Storage Structure
(identifvlj^'F^j^ 'T'9~ ^
( 3) 'Replacement Dwelling
(6 ) Attached / Detached Garage
( 9 ) W 0 A S.' /i^''y?t requires a 3’ (minimum) structure
' ^ j ^ *" 9€ttC|9CK to 3 W61I.
( ) Permit No.
OTWMD 'Must have Sewage System Approval
' from OTWMD prior to issuing Site Permit.
/* Contact Rotlie Mann at 218-8B4-5533(om^) (DLR/teTERISTICS OF PROPOSED W.O.A^S.CHAR(WATER ORIENTED ACCESSORY STRUCTURE)OutsideX
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside Dimei^on
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
Outside Dimension /' j?
So. Ft. y/ o ■2.^
Setback to Lotline
Ft. X
^ /0
^ Ft.& c^.^ '
Ft. X Ft."Ft,”Ft.",Ft. X
Sq. Ft. \
Setback to LotliHe
Setback to Right otVI^v____
Setback to Ordinary HigmWater ^el __
Elevation Above Ordinary Hig)l^ater Level
Setback to Septic Tank _>
Setback to Drainfield /
^etback to Bluff /
Maximum Prp(5osed Height
Roof Chj#nge ( ) Yes ( ) No
Bathroom Proposed ( ) Yes ( ) No
Sq.Ft.______\
Setback to Lotline \
Setback to Right of Way
Setback to Ordinary High WafhLb^vel __
' Elevation Above Ordinary Higb^TOr Level
Setback to Septic Tank_
Setback to Drainfield /
Setback to Bluff /
\ Maximum Proposed Height
( ) Boathou^
( ) Gazetp
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft."Ft.&Ft.”
Setback to Right of Way ^ ^ Ft."^^/ ^ _
Setback to Ordinary High Water Level 4-4^
Elevation Above Ordinary High Water Level ^ ^ Ft.
Setback to Septic Tank Ft,
Setback to Drainfield < ^ R^
Ft.&Ft,"■F’Y ■t."
Ft,"
Ft.
Ft.
3-FN
Setback to Bluff Ft.Ft.Ft.Total Bedrooms XS '
Maximum Proposed Height ^ 3
Roof Change ( X) Yes ( ) No
Basement ( ) Yes (X) No
Walkout Basement ( ) Yes (side protile required) No
Ft.Ft.Ft.Ft.Ft.
( ) Screen Porch
( ) Storage Structure
Topographical Alteration / Earthmovinq
□ None
' Must include on scale drawing,
additional Permit may be required.
CHARACTERISTICS OF LOT:
Lot Area
20 Cubic Yards or Less '□ 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More'
I
.Ft.ter Frontage Bluff ( ) Yes (XI No
O // K'lg? PrTO
mmim xioo =.%Total Lot Area (FT^)btal Impervious Surface Onsite (FT!)Impervious Surface Ratio
TH/S 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. 1 further agree that any plans and specifications submitted herewith shall become
a part of this permit application. 1 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 & Resou^e Management office once the building footings have been constructed.
'X7- .rTyyyy PrTt^SDate:
Signafure^Property Owner/^^r/jfof^dwner )
Date:
miKi310PROJECT(S) TOTAL SQ. FT.
Comments: Ztf>Z7;AZa /OAZZ ^ 72? (PZ'
TAlj-^y TMf. k/<JT Ip \JpnM L
No. BK — 1003-0407 ^ ^ 329,582 - victor Lundeen Co., Printers •/Fergus Fails, Mlnnswla :Form
«
WHITE - Office
GOLDENfiOD - Inspector
YEJ.LOW - Owner (after issue)
PINK - Assessor
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. cAPLEASE PRINT OR TYPE ALL INFORMATION
TWPNAMERANGESECTIONTWP NO.LAKE/RIVERLAKE/RIVER NAMELAKE / RIVER NO.CLASS
(37-T&rA/2-/S
PROPERTY (E-911) ADDRESS ^ •y C)PARCEL NUMBER (S)
'}
LEGAL DESCRIPTION r"'
Daytime Phone No.Mailing AddressFirstInitialLast Name
/yy^T yir^/P0/?/s'yyuj:^£ ;Property
Owner yf'/AJT' y/yy
Self /^fPfy’ c^r-i ^Contractor
Name
Lie.#S r/' L/: -jy -ly./Y/^1
PROPOSED PROJECT (please circle the appropriate number)
(2 )Add’n to Dwelling
( 5 ) RCU/Year______
( 8) Storage Structure
ONSITE WATER SUPPLY
t"^ ) Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM
( ) Permit No.__ii
(^ OTWMD 'Must have Sewage System Approve!
' from OTWMD prior to issuirta Site Permit.
Corttact Roitie Martn at 218-864-5533
{ 3) 'Replacement Dwelling
( 6 ) Attached / Detached Garage
(9) W.O.A.S.
(1 ) New Dwelling
(4) MHA'R^
(7) Add’n To Non-Dwelling
J,T01 Non-Conf. Replacement (identify)_^
111 1 Other (identUvl . ' ywLf/J -£ ^ ^
Existing Dwelling to be removed prior to -'/£ ,//')/.j-\ }J ./y ; (/ 7 7/Xr£"
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
. on
•' -f
4-y77 lI II J
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside ,
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension ///Ft. X Ft."Ft."Outside Dimension___
Sq. Ft. ____
Setback to Lotline __L
Setback to Right of Way
Setback to Ordinary High Water Level
Elevation Above Ordinary High VVater Level ^
Setback to Septic Tank
Setback to Drainfield --------Ft.
Setback to Bluff ' i ~ ^qri pP ^ Setback to Drainfield
Total Bedrooms 4^ 7 _ „ 0 / ^back to Bluff
Maximum Proposed Height ^ Ft. / ■£? p ,
Roof Change ( -^Yes ( )No
Basement ( )Yes ( •-) No Roof Change ( )Yes ( )No
Walkout Basement ( ) Yes (s/de profiie required) ( A’.') No Bathroom Proposed ( ) Yes ( ) No
Ft. X Ft."/Ft. X
Sq. Ft.
/Setback to Lotline
Setback to Right of Way
Setback to Ordinary High Water ^el
Elevation Above Ordinary Higl/Water Level
Setback to Septic Tank
-r'/Sq. Ft.
Setback to Lotline
Setback to Right of Way
Setback to Ordinary High Water..^vel __
' Elevation Above Ordinary High Water Level
Setback to Septic Tank / Ft\
Setback to Drainfield /'
Setback to Bluff '
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
**Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft.&Ft.”Ft.&Ft."Ft.”Ft.&VFt." - V/ 'df i
'.i ./Ft."Ft \/Ft.Ft.
Ft.Ft.iVr V X7
Ft.Ft.
Ft.Ft.
Ft.Ft.
( ) Screen Porch
( ) Storage Structure
* Must include on scale drawing,
additional Permit may be required.
Topographical Alteration / Earthmovina
□ None □ 300 Cubic Yards or More*□ 20 Cubic Yards or Less *□ 21 Cubic Yards - 299 Cubic Yards*
CHARACTERISTICS OF LOT:/ c'y'J
Bluff ( ) Yes ( >) No
>./.Ft.6q. Ft. ' / Water Frontage /Lot Area_;n
A ~T irImpervious Surface Ratio;-^X100 =.%Impervious Surface RatioTotal Impereious Surface Onsite (FT!)Total Lot Area (FT!)
TH/S 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 Management office once the building footings have been constructed.
Date:
Signaiure of Property Owner / Agent for Owner6lylo^Date:
2>\0 Land & Resource Management Office i
PERMIT FEE $RECEIPT NO.PROJECT(S) TOTAL SQ. FT.,
^ 7,-''' -‘hjJi AOil/yv 44 lO/l
/O Z: ;' - yy 7 /1,' /■-7~Comments:
y /p'/T'/. /u'Ai r T ; y ‘I ■
- .• X '■-'i''y
/i!/-n r:.' }/.7A - ■4 4 /^ N’ A
'orm No. BK — 1003-0407 329,582 • Victor Lurtdeen Co., Printers * Fergus Falls. Minnesota
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
Vo^i'c^lX' Ft.Structure Set Back from Ordinary High Water Level Ft.
Structure Set Back from Top of Bluff Ft.Ft.
Ft.Structure Set Back from Road Right of Way Ft.
^ -it'mlStructure Set Back from Lot Lines Ft.&Ft.Ft.&Ft.
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 Ft.Ft.
Land Slope at Building Site %%
3 vAuVV ^ VoMoalcJ^
Inspector’s Comments / Sketch:
%
I
Inspector's ^gnature
b-a -ag
Date of Inspection
IP'UA-
Time of Inspection
^'\j^roject Approved (p f?
^ Date/Initial
OTTER TAIL COUNTY
Conditional Use Permit#
Property Address ^ (___________Owner’s Name
1^Twp. 13^/ Range ^0 Twp. NameLocation: Lake Sec.
n^-QvO ~^9-0
t
Work Authorized: rp feViV ^ iroorMer ^ /O' hp^ch gi/et'
o-f 5E- W trf C^Hmi f^-ho
'x,/dr\ -fo lOt}'-(- -froM Lq{ OLfh/U^ S£
Ld l OH-WL, pt/f" 6>^vUU Q-P
ToOKeci jWjn ^ I5'f '^oM N6 pp/ticn (?f -fg
(oL ^ i/K\i+ Ctl/S-^e-^.y ,
rd^
\
(^d-yJL [ tlot-r;.T^ts L i r i . n
tO re/Mct (>e,UAi;| ^rbce^^s-ed- ^
^ djoe ^ ^
/
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 wafer drainage that may occur.
3. If the terms of this permit are violated the entire permit may be revoked and the owner may be subject to legal prosecution.
4. 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,
and shall be maintained there until completion of such work.
5. NOTIFY DEPARTMENT OF LAND AND RESOURCE MANAGEMENT, TELEPHONE (218) 998-8095, WHEN AUTHORIZED
WORK HAS BEEN COMPLETED.BK-1004-046
319.M3 * Vkaof LunOaafl Co.. Pnnnn • Fetguc Fein. MN > 1~aoO-M5-487D
Pre-Application Site Inspection Request
Lake / River No. Lake / River Name Lake/River Class Section Twp Name
Qh lAParcel(s) No.Property (E-911) Address
Property Owner Information:
Name(s):
Address:
£,4/- 443- 43 5tX-Daytime Phone:
Type of Request:
Bluff;'Determination Verify SetbacIStake Setback
OHWL:Determination Stake Setback Verify Setba
Stringtest:Determination
Non-Conforming Repair or Replacement Structure:Confirm Consistency With &(isting Structure
ALMiscellaneous:
Describe Request:
A scale drawing must accompany Pre-Application Site Inspection Request
& request must be staked onsite
u.Property (^ner Date
Received By:
ind s Resource Management Staff Date
INSPECTION COMPLETED (Inspection must be done within 10 days of receipt):
"^Date Onsite Inspector*^Date Property Owner Notified
(Inspector must provide site drawing or field notes on other side.)
mbowman Application & Forms Pre-Application Site Insp Request Formf 0/1/07
I Hi dr^ingI form -r:
m! ;- -i ]■i:
nS~<^O0O ^ OB 0 oa^ ^ 9\3 a oo(92.00(399?:T Tax Parcel Number(s)
The scale drawing must inc ude the outside dimension (lotlines) of the property above the ordinary high water ievei, and must identify the type,
size (square feet), and iocation of all existing and ppposed structures, additional onsite impervious surfaces, road right-of-way(s), ordinary high
water level(s), septic tank(s), drainfield(s), bluff(s) & wetland(s). Must aiso include all proposed topographical alterations.
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impervious Surface Ratio
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M M ! R ! I ['If,!:i Date
?29,Oe6 * vtcwf Lund»n COm Prints™ • Fergus filli. MN • 1-800-346-4870i. n.: .ll i.1 i i, 4.;.
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SCALE DRAWING FORMi ■■
g?c:?o 9 9 ^ 02.0e>c^9 9 3 \Tax Parcel Number(s)
4..The scale drawing must include the outside dimension (lotlines) of the property above the ordinary high water level, and must identify the type,
size (square feet), and location of all existing and proposed structures, additional onsite impervious surfaces, road right-of-way(s), ordinary high
water level(s), septic tank(s), drainfield(s), bluff(s) & wetland(s). Must also include all proposed topographical alterations.
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(Must Complete Worksheet On Other Side)
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SCALE DRAWING FORM X 1
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Tax Parcel Number(s)
The scale drawing must include the outside dimension (lotlines) of the property above the ordinary high water level, and must identify the type,
size (square feet), and iocation of all existing and proposed structures, additional onsite impervious surfaces, road right-of-way(s), ordinary high
water ievei(s), septic tank(s), drainfield(s), biuff(s) & wetland(s). Must also include all proposed topographical alterations.
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Impervious Surface Ratio
(Must Complete Worksheet On Other Side)
Scale
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IBK —0207 !* victc| Uindeen Co, Printars • Fwgtis Pall*. MN * l-abO-346-4870. j-..
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329^86
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IMPERVIOUS SURFACE CALCULATION WORKSHEET:
List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing):
Ft2
Structure(s);
Deck(s):
Driveway(s):
cy Ft2Patio(s):
^ ^ Ft2Sidewalk(s):
Stairway(s):
Retaining Wall(s):
Landscaping:
(Plastic Barrier)
Other:
j Ft2
R2
TOTAL IMPERVIOUS SURFACE ' LOT AREA
TOTAL IMPERVIOUS SURFACE:
LOT AREA:
.%X 100 =
IMPERVIOUS SURFACE RATIO
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Tax Parcel Number(s)
The scale drawing must include the outside dimension (iotiines) of the property above the ordinary high water level, and must identify the type,
size (square feet), and iocation of aii existing and proposed structures, additionai onsite impervious surfaces, road right-of-way(s), ordinary high
water ievei(s), septic tank(s), drainfieid(s), biuff(s) & wetiand(s). Must aiso inciude ail proposed topographical alterations.
/ - 'Wif'Pr %Scale Impervious Surface Ratio
(Must Complete Worksheet On Other Side)
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Signature of Property Owner Date
Lundeen alls. MNBK-s^0207.s-*..F^rgusi
329 086...*-VictoI I
•800-34&4870
illCo, Pnmer
r
Office
OwnerWhite •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 /f n c, p 1^^ k-q ^AND /
LOCATION
rz- Hocrffte-rf^lu (j-O A/*iog.
TWP NameTWPRangeLake Classif.Sec.Lake NameLake No.
IDENTIFICATION: Please Print Alt Information
Zip No.Tet. No.ISi^lling Address— No. Street. City and StateFirstInitialLast Narrte
307/)9^£N/Owner
^ '< Vi S“CS'7m rJ 7SeCFNameContractor
J
Architect Name.
RESIDENTIAL PROPOSED USE;NONTYPE OF IMPROVEMENT:
I Building
( ) Alteration
RESIDENTIAL PROPOSED USE:
( ) One Family Dwelling
( ) Multiple Dwelling
(■\>^ther
Units
( ) Other Size
ESTIMATED COST OF IMPROVEMENT $
DIMENSIONS:
Basement: ( ) Yes {v^ No
Stories above basement: .......
Sq. feet (outside dimension).....
Bedrooms
TYPE OF SEWAGE DISPOSAL;
( ) Public
(vF^ndividual Septic Tank,
WATER SUPPLY:
( ) Public
(vk^ndividual Well
PRINCIPAL TYPE OF FRAME:
( ) Masonry
( ^^ood Frame
( ) Structural Steel
( ) Other — Specify
/
etc.
Baths...
fCHARACTERISTICS:// f 0 ZJO \feet.Maximum depth of lotWater frontage is feet.square feet.Lot Area is 7S-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 St^te highway right of v^ay..........
Side yard is .............................. and.........
Structure will be located
feet
7^3 .feet.feet - from road right of way is
.............feet.
.feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Sewage System Permit must be obtained before installation).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 ONL Y AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STA TE STA TUTES.
I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand
I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project.
IiK/2-L ~ 'yyDated,V'i ignature 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.
Shoreland ManagetTlSnt Official
Dated
Receipt No.
Comments^Aro OTTefZ C^Q <Kf\Ty r
<5
Form No. MKL-0286-019 229971@
VICTOR LUNOEEN CO.. PRINTERS. FERGUS FALLS. MINN.
•k.
iWhite* - Office
YeMow — Owner
Pink — Assessor ,
Goldenrod — Inspector
r-#%SHORELAND MANAGEMEM - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739-2271 — Fergus Falls, Minnesota 56537
APPLICATION FOR SITE PERMIT
’
\
Permit No..!LEGAL
DESCRIPTION / /T ' /11. FK f\AND /
LOCATION
J;
TWP NameTWPRangeSec.Lake Classif.Lake NameLake No.
IDENTIFICATION: Please Print All Information
Zip No.Tel. No.Mailing Address— No. Street. City and StateInitialLast Name First
Owner
11
NameContractor
Architect Name.
NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT:
' ' cSpecify;.{ ) One Family Dwelling
( ) Multiple Dwelling
( )-Other
I ^New Building
( ) Alteration Units>
( )Other Size
ESTIMATED COST OF IMPROVEMENT $
DIMENSIONS:TYPE OF SEWAGE DISPOSAL;
( ) Public
( J Individual Septic Tank, etc.
WATER SUPPLY;
( ) Public
( j.'Tndividual Well
PRINCIPAL TYPE OF FRAME:
( ) Yes ( ^1' NoBasement:( ) Masonry
( I Wood Frame
( ) Structural Steel
( ) Other — Specify
Stories above basement:
Sq. feet (outside dimension)
Bedrooms ..............................Baths
/CHARACTERISTICS;I ZloI / •:feet.feet.Maximum depth of lotsquare feet.
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 vyay.....
Side yard is
Structure will be located
Water frontage isLot Area is
feet. (Building Line)
feet
■feet.feet — from road right of way is
y / : Iand ..............feet.
■feet from septic tank (Sewage System Permit must be obtained before installation).
feet from soil absorption system (Sewage System Permit must be obtained before installation).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.
I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand
I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project.
/Dated.
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
rPermit Fee $.Receipt No.
Comments:
Form No. MKL-0286-019 229971@
VICTOR LONDEEN CO.. PRINTERS. FERGUS FALLS. MINN.
INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL
IS I
MINIMUM
Shall Be ^Sq. Ft,
Lot Area (Square feet)Sq. Ft Sq. Ft.
Water Frontage Ft.Ft.
/^rBuilding Set Back from High Water Mark Ft.Ft.
Building Set Back from State Highway Ft.50 Ft.
ZS'Building Set Back from Street or Road Ft.40 Ft.
Z£Z&_l^Ft.Side Yard &Ft.
Rear Yard Ft.Ft.
Occupied Building to Septic Tank Ft.10 Ft.
Occupied Building to Absorption System Ft.20 Ft.
Elevation at Building Line above
High Water Mark_____________•5 Ft. 3 Ft.
Inspector's Comments:
Inspectdi's Signature
//T)
Title
Inspection
Dated Iz- G-Agency
viere* lunkcii » e».. Mnnitt*. rcMU* r«x».
»- 'iI1
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i TT^\L I ;i 1ii1
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V
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
White — Office
Yellow — Owner
Pink — Assessor
Goldenrod — Inspector
Permit No..LEGAL
Date,DESCRIPTION
AND
LOCATION
jZ'-y9r n/Ayr/2j Jy/tr-
Lake Classif.^ TWP NameLake No.Sec.TWPLake Name Range
IDENTIFICATION; Please Print All Information
Last Name Fin initial Tel. No^Zip No.Mailing Address— No. Syyt, Citv and State_________
_________________rye
CL YT/
; .rOwner
/
Name yJ oContractor
Architect Name.
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:
^.•^One Family Dwelling
( ) Multiple Dwelling
( ) Other
NON-RESIDENTIAL PROPOSED USE:
New Building
( ) Alteration
( ) Other
Specify:.
Units
Size
ESTIMATED COST OF IMPROVEMENTS 3'*SoO >(omit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS:
Basement: ( ) Yes No
Stories above basement: ......
Sq. feet (outside dimension)
Bedrooms
( ) Masonry
Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
l^) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
Baths
HEATING:
( ) Electric ( ) Gas
( ) Coal
Other:
Type of Roof:K.) No ( ) Oil
Y) No ( ) None
( ) Unit
CHARACTERISTICS:
...Lot Area is square feet.Water frontage is.
feet. (Building Line)
...............................feet
feet.7 Z./Z.Building set back from high water mark is...................
Land height above high water mark at building line is
Building set back from State highway is.......................
Side yard is
Building will be located
Building will be located
.^(.....±7.
,5Z.feet — from road or street is
............Y.frI.
feet.
./...and feet. Rear yard is
feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Cesspool, Drainfield, etc.).
feet.
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.
Dated.
7 7
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 $ State Surcfiarge $
______
Comments: AA
7^
Form No. MKL-0771-002
vicTPR LuaeciH t M-. pkihtimi. rcaaui rakt*.
.158899
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
White — Office
Yellow — Owner
Pink — Assessor
Goldenrod — Inspector
/
' / CyT
/Permit No.,LEGAL /
DateDESCRIPTION• -r. r -
AND
LOCATION
// '//
Lake Classif.Sec.TWP TWP NameLake No.Lake Name Range
IDENTIFICATION: Please Print AM Information
Last Name Initial Mailing Address— No. Street, City and StateFirst Zip No.Tel. No.
' SiOwner
f' 4
NameContractor
Architect Name,
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE:
( ) New Building
( ) Alteration
( ) One Family Dwelling
( ) Multiple Dwelling
Specify;,
Units
. »■ y -4' 7 ''( ) Other ( ) Other Size
ESTIMATED COST OF IMPROVEMENT $ j 'll (omit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS;
( ) Masonry
( ) Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
( ) Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
I ) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
_________I ) Central
Basement: ( ) Yes ( ) No
Stories above basement: ........
Sq. feet (outside dimension) ....':
Bedrooms Baths
HEATING:
( ) Electric ( ) Gas
( ) Coal
Other:
Type of Roof:( ) No ( ) Oil
( ) No ( ) None
( ) Unit
CHARACTERISTICS:
/ 5Lot Area is square feet.Water frontage is,
feet. (Building Line)
...............................feet
feet.
Building set back from high water mark is...................
Land height above high water mark at building line is
Building set back from State highway is........................
'*^ide yard is....................
Building will be located
Building will be located
e.
feet — from road or street is feet.
and .......................................feet. Rear yard is
feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Cesspool, Drainfield, etc.).
feet.
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.
Dated,
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.
aDated
Shoreland Management Official
Permit Fee $.State Surcliarge $.
Comments:
/
c
Form No. MKL-0771-002 158899
VICTO* UiaOeCH 4 CO.. MlHTCRt, fCROUl
f
INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL IS i MINIMUM Shall Be 4-Sq. Ft
Lot Area (Square feet)Sq. Ft.Sq. Ft.
Water Frontage Ft.Ft.
Building Set Back from High Water Mark Ft.Ft.
Building Set Back from State Highway Ft.50 Ft.
Building Set Back from Street or Road Ft.40 Ft.
Side Yard &Ft.&Ft.
Rear Yard Ft.Ft.
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 Ft.
Inspector's Comments:
Inspector's Signature
Title
Inspection
Dated
/7 19
Agency
VICTOR LUNOCCN > M..
GRID PLOT PLAN SKETCHING FORM.feet/inches.Sca/e; Each grid equals
^Application for Building Permit Dated.
Application for Sewage System Permit Dated
.19.
; r.19
Building Permit Number.
Applicant agrees that this plot plan is a
Dated
i I
1 i■-1 ■Vs>
^■tt
!I-1 iIi-
159104 ®MKL-0871-029 VICT«<» UIHtCea 4 M.. FCB4US racLB. HtN«.
■ ’f ys--ji^ :?if ■
SAf • ® ?"’■:’
ft t** f % t «'if ■ 'i?»'» ;£m
WfiP^ip'W r!« ■■
,fm:^m- -twttv V:^
■ ^ "’ ■" f^rwry 26, 1973 ^ "?'■'
^ cAi^^r .; I' ^V 1''- '■.n - H
Mr. Robert Madsen ' J: #: ^ - ' ‘‘
Route #l .. -t %.:4
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-‘i r-SDear Mr. Madaimt r-A .^:-■-•
s We are nov in the process of reviewing permits that ware Issued
In 1972.'l:i?■ ■■
' ' ■'O:■f '-Please notify us when your footings are InstaHed^ so that we MB
make an Inspection.
Sincerelyf
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1SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 — Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
White - Office
Yellow — Owner
Pink — Assessor
Goldenrod — Inspector
%4
Permit No..LEGAL
/T/f?Date.DESCRIPTION
AND
LOCATION
/.^ JJ±A/ /4Af6A-
Sec.TWP TWP NameLake Classif.RangeLake No. Lake Name
IDENTIFICATION: Please Print AM Information
Mailing Address— No. Street, City and StateLast Name First Initial Zip No.Tel. No.
AO / '/li/Pr/T /Owner
2(TroNameContractor
Architect Name.
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:
(V) One Family Dwelling
( ) Multiple Dwelling
NON-RESIDENTIAL PROPOSED USE:
New Building ef-^A
(i>by3b'
Specify:,
( ) Alteration Units
( ) Other ( ) Other Size
ESTIMATED COST OF IMPROVEMENT $ U , O e i>lomit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS:
Basement: ( ) Yes No
Stories above basement: .......
Sq. feet (outside dimension) .....
Bedrooms
( ) Masonry
(^ Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
(/AJ Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
/<
Baths
HEATING:
( ) Electric ^>0 Gas
( ) Coal
Other:
Type of Roof:( ) No ( ) Oil
( ) No ( ) None
( ) Unit
CHARACTERISTICS:
Lot Area is square feet.Water frontage is ,
feet. (Building Line)
...............................feet
feet.
Building set back from high water mark is
Land height above high water mark at building line is
Building set back from State highway is........................
Side yard is..........
Building will be located
Building will be located
r:.±.
feet — from road or street is feet.
and feet. Rear yard is
feet from septic tank (Sewage System Permit must be obtained before installation).
feet.
Z.fi:
feet from soil absorption system (Cesspool, Drainfield, etc.).
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.
Signature of Owner ^
described in the above statement. This permit is grantee! upon the
/r. /? ?Dated.
Permission is hereby granted to the above named applicant to perform the workPermit:
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.
IO // /??Dated r Shorelan^ Management Official
Permit Fee $.State Surcharge $.
Comments:
S
fC<P A'i
Form No. MKL-0771-002
VH.IM iuavna • e*. PUi*«t|»«. Ft*«va FM.ii
15S899
.>
1SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
White — Office
Yeliow — Owner
Pink — Assessor
Goldenrod — Inspector
r
Permit No„LEGAL
Date.DESCRIPTiON
AND
LOCATION
^ 139// Void
Lake Classif.Sec.Lake No.Lake Name TWP Range TWP Name
IDENTiFICATION: Please Print AM Information
Last Name First Initial Mailing Address— No. Street City and State Zip No.Tel. No.
AJ40S^/y /P/zT / //(//'//.Owner
NameContractor
Architect Name.
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE;
(y> One Family Dwelling
( ) Multiple Dwelling
NON-RESIDENTIAL PROPOSED USE:
^ New Building
( ) Alteration y gg" '
Specify:,
Units
( ) Other ( ) Other Size
ESTIMATED COST OF IMPROVEMENT $O O (omit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS:
Basement: ( ) Yes No
Stories above basement:
Sq. feet (outside dimension)
Bedrooms
( ) Masonry
(X) Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
(/A) Individuai Septic Tank, sXc.A/^sr^^e-
WATER SUPPLY:
( ) Public
(X) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
3 Baths
HEATING:
( ) Electric
I ) Coal
Other:
Gas
( ) None
Type of Roof:( I No ( ) Oil
( ) No
( ) Unit
CHARACTERISTICS:
3oe 9.33..Lot Area is square feet.Water frontage is,
feet. (Building Line)
...............................feet
feet.
Building set back from high water mark is
Land height above high water mark at building line is
Building set back from State highway is........................
Side yard is.........
Building wiil be located
Building will be located
r.±.
feet — from road or street is feet.
and feet. Rear yard is
feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Cesspool, Drainfield, etc.).
feet.
.33..
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.
/r /f ?Dated.
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.
1C> //Dated
Shoreland Management Official
Permit Fee £ ^State Surcharge $.
Comments:
-IkZ (C-C (jLji
/ ‘H-7*^
Form No. MKL-0771-002 158899
VICTOa UJHMCM 4 eft.. PKIHTEai. FERtUt FK.LI. HIHR