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Home My WebLink AboutChar-Mac Resort_12000990413000_Shoreland Permits_SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W ;te - Office V low —'Inspector Pli.. — Owner Card — Owner Permit No.LEGAL Date DESCRIPTION /.AND >•0 I P I ''LCf /yNLOCATION Lake No.Lake Classif.Lake Name Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Mailling Address —No..^ Street„.-City and StatefiiL\ PCS:.Tel. No..First Initial Zip No.a me OWNER SEWAGE SYSTEM INSTALLER Name. 1^ This System will be ready for inspection on., 19. This space for office use only .19 .M Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ^70 Sq. F,./.fTiP GIs.Sq. Ft.Capacity nlTFt.Ft.Ft.Distance from nearest well oFt.Ft.Distance from lake or stream Ft. Ft.Distance from occupied building Ft.Ft. zul 10Distance from property line Ft.Ft.Ft. iFt.Ft.Distance from bottom to Water Table Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on , 19., Time .M By PERCOLATION TEST DATA: Date of First Test 19 , 19 , Rate rb L.I..Date of Second Test , Rate 1st Test Taken By (■rf,/• r.3.-...I2 First Test -I- 2nd Test s Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work inAgreement; strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individual Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been Inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) ^ iDated Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. Tms permit is granted upon express condition that the person to whom it is granted, and his agents, employees and workmen shall confornvio all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: 9// b/7 GIssued Date:4. nd Management OfficeShoj "^1Fee $Surcharge $ I 0 @ /oci ! Do^/C) n fifipi?'—^Comments:.\at. Form No. MKL-0771-003 @ VICTBB LUNBECH B BB.. BBtHtCBB. ElBSliS FEB1.B HtHM 15S906 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR PERMIT TO INSTALL SEWAGE DISPOSAL SYSTEM W ;te - Office V low - Inspector Pli.. Card /Owner Owner Permit No.,LEGAL Date DESCRIPTION AND LOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name Mailling Address —No. Street, City and State Tel. No.First Initial Zip No. OWNER SEWAGE SYSTEM INSTALLER Name, This System will be ready for inspection on., 19. This space for office use only 19 Date Rec'd Time Rec'd Phone Call Rec'd By Owner or Agent Signa^ture NUMBER OF BEDROOMS;ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Sq. Ft.Capacity Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied building Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Ft. Ft.Distance from bottom to Water Table All distances are shortest distance between nearest points RECORD OF TESTS: Inspiection was made on 19,, Time jVI By PERCOLATION TEST DATA:Date of First Test 19 , 19 > Rate Date of Second Test , Rate 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By Agreement: strict accordance with ordinances of the County of Otter Tail, Minnesota and Minnesota Individuai Sewage Disposal Code Minimum Standards set forth by Minn esota Department of Health. Applicant agrees that plot plan, sketches and specifications submitted herewith and which are approved by Shoreland Management Offi cial shall become a part of the permit. Applicant further agrees that no part of the system shall be covered until it has been inspected and accepted. It shall be the responsibility of the applicant for the permit to notify the County Shoreland Management that the job is ready for inspection. (Call or use attached mailer notice.) The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do all such work in Dated, Signature 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 agents, employees and workmen shall conform in all respects to ordinances of Otter Tail County Minnesota. This permit may be revoked at any time upon violation of any said ordinance. NOTE: Permit void if work is not commenced within six (6) months. Permit: Issued Date: Shoreland Management Office Fee $Surcharge $ Comments;. certificate issued Form No. MKL-0771-003 .158906 VICTOt UiNBCCH 6 CB.. BtlHTCBB. fCMBUB r«LL8. • tr • INSPECTION RESULTS Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEPTIC TANK SEEPAGE PIT DRAIN FIELDCATEGORY Actual Should be Actual Should be Actual Should be '■j/^c, s FCapacityIGIs.GIs.S F SF SF /Distance from Nearest Well 75F F 50F F R SdDistance from Lake or Stream ' FFF F F F « FDistance from Occupied Building 10 2020FFFF F -/r Ff 0'Distance from Property Line 110 10 10FFFF FI/ FDistance from Bottom to Water Table 4 4FFFF Ff Inspector's Comments: n c:h^'I L r~>-A ^ hIDate of Inspection Time of Inspection..M / signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs = Gallons SF “ Square Feet * Linear Feet / Job TitleF AgencyMKL-0771-003-Backet : 0 ■ vy- ' i rj' .■ ^ ; yt f-. r.'ll PERCOLATION TEST DATA Price $1.00 per pad. SHORELAND MANAGEMENT OTTER TAIL COUNTY Fergus Falls, Minnesota 56537 Ph. No. Owner:Mailing Address: Last ^ame Y StateMiddle Zip No.St. & No. /3 & City yLegal Description:/ SEC.TWP.TWP NAMELAKE OR RIVER NO.NAME RANGE f /______.y______^_____y_________Lf TEST HOLE NO. 2TEST HOLE NO. 1 ////9 i£Depth to Bottom of Hole inches; Diameter of Hole inchesDepth To Bottom of Hole,inches;Diameter of Hole inches yjy Date . ^ /t ^ 19 7.^Depth, Inches Soil Texture Depth, I nches Soil Texture;t3p-py^'^ ^PTtJL^ // Percolation • Test By___ Percolation Test By .a31"yJ^.^Cc^ytUAy LUFirm Namg,OC FirmNameD Tnr' yomr\CC AU-^ . y’y^, 3r3^X LU Address.OC Address <3^^c/)Otter Tail County License No.,Otter Tail County License No.,I- LUMeasurement, Inches Depth in Water Level, Inches I-Measurement, Inch Depth in Water Level. Inches Time Remarks Time Remarks oT^Alp 3 L 3^ 5''2^S' '^ozH r/y 2^16^S^'3oSt'.5c /c r^7 S'-3o%’ 5o T%/3-i2 ’>/32Z53L. Sdc/yy-A S;v<3S:’>. yi j?T1UEi-__Z/JS '- So 7y: So LIJ S: So 6 -/r9: c)0 yLA/L-(jy39-00 9fo>a 1 U'2/5^/29-V^9.' SL9^ 'Q *9 3/A (o y 9 :jA<p^3 2d 2o ^ MKL-0871-028 T591 yS viCTo» voioitN « eo- Pjpirtas, rtusus falls, wti See Booklet, "How to Run a Percolation Test" by Agriculture Ext. Service, Un. of Minn. j NoY^:J^ipt. 'i^o h-e- 'fiOiy^ UJc U Utr\J -fo^ (_Scoja) Jr ct/T* /V o K /o ' cuk*^t-e^ C/ox,5V? cSide, o i' <jJci^<L\- LVC-t^t« /- a,ho[/* uJcCtei'I • i^C- "t'o C /" «3X J'(jJoT^f ^ Side, o-^ Sf-uJ&h /<'»11 />c C<f>f>pe^ /x>i' .d^tSTc~to a-f1f //n ii ^Lo\/e . — r<ujU! '' M C)15 7JIC/*iC/>e!^(_A'B/m'b ■PP-'3.PP.S. A-h$V:4.'V 4'--7 fXhSJ^ n yytL4__A 4- t t M H FM-t )-/ V -+4^f=f4-f4+—y 44 I 44^1->>r-»-t-t 4H- I lb'1 • '":1 ^ <! IS6' ^— P(//*?p/"'! ¥ ' iio' « ; iHcmB. W£LL \ i A RCCH4^- I\I / . APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor Permit No.PLEASE PRINT OR TYPE ALL INFORMATION RANGE TWP NAMELAKE / RIVER NO. LAKBRIVER NAME SECTION TWP NO.LAKE/RIVER 'Zi? 31 /37 E-911 ADDRESSPARCEL NUMBER (S) /fSTJi cl, t Initial Mailing Address ^ J ^ .PayJnme Piio t!L\ iW ^1 / ^ /-laJ 73 577/ LEGAL DESCRIPTION t one No.Last Name First /Her utau ( 7k YProperty Owner ! 7(50Lq,Contractor Lie.#aoi 3 a ONSITE WATER SUPPLY (V^ilndividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM „ . PROPOSED PROJECT (please circle the aparmrial^umber) (1) New Dwelling ^^^dd’n to Dwelling^ (3) ’Replacement Dwelling (4) MH/YR_______ (5) RCU/Year_______ (6) Detached Garage ( 7 ) Add'n To Non-Dwelling (8 ) UtiliW^tg Structure (9 ) WOAS iT^^g Dwelling to be removed before ( ) Permit No. ( )OTLSD* * This permit is only valid after verification from the 0. T.L.S.D. that a conforming sewage system will be installed to service this lot contact Rollie Mann at 864-5533.&ther [ARACTERISTICS OF PROPOSED NON-DWELLINGCHARACTERISTICS OF PROPOSED DWELLIN^^ Outside Dimension Ft. x | Ft^ " Setback to Lotline ^0 Ft. & «SD Ft." Setback to Right of Way Ft." l Setback to OHWL "J S' , F*- n ^ Elevation Above OHWL*’ ~ 3 Ft. ^ / /n Ft. b C/Ft. CHARACTERISTICS OF PROPOSED WOAS Outsides. Dimension s_____ Setback to Lotlinbv Setback to Right of ^ Setback to OHWL__ Elevation Above OHWL Setback to Septic Tank Setback to Drainfield _ Setback to Bluff____ Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No OutsideX DimensionX______ Setback to Lotlihe ___ Setback to Right ontey Setback to OHWL ^ Elevation Above OHWL, Setback to Septic Tank _ Setback to Drainfield__ Setback to Bluff_____ Maximum Proposed Height ( ) Boathouse ( ) Gazebo Ft."Ft. x Ft."Ft. x Ft.&Ft."Ft.&Ft.” Ft."Ft.” Ft.Ft. Ft.Ft.Setback to Septic Tank__ Setback to Drainfield ^ Setback to Bluff ^ (n Maximum Proposed Height Basement_____ Walkout Basement Total Bedrooms Ft.Ft. Ft.Ft.Ft. j/^NoYes FP Yes No ( ) Screen Porch ( ) Utility Structure(Ja^ Project/Lotlines/Right-of-ways Must be Staked Onsite **Project/Lotlines/Right-of-ways Must be Staked Onsite Grade/Fill/ExcavationSpoil Disposal a Onsite (scale drawing req □ Offsite □ Within Shoreland Area □ Outside Shoreland Area □ Yes (scale drawing required) CHARACTERISTICS OF LOT: Sq. Ft..Ft.Bluff Onsite,Lot Area.Water Frontage Impervious Surface RatioX 100 .% Total Lot Area Surface Onsite (FTh (FTP 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 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: Signature of Property Own Date: Land S Resourc^i RECEIPT NO.PERMIT FEE $ Project/Lotlines/Right-of-Way MUST be Staked ^ Onsite Prior to Submission of Application.RECGIVEOComments: OCT " 3 200e land & RESOURCE 301.934 • Victor Lundeon Co.. Pnntors • Porgut Pells. MN • 1-800-346-4870Form No. BK — 0500-002 WHITE - Inspector (after issue) PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone; (218) 739-2271 • FERGUS FALLS, MN 56537 IPermit No.PLEASE PRINT OR TYPE ALL INFORMATION TWP NAMETWP NO.RANGELAKeRIVER NAME LAKE/RIVER CLASS -V&0 SECTIONLAKE / RIVER NO. 5L_l‘f,^\ /j-fji lAL /37 Cov ; E-911 ADDRESSPARCEL NUMBER (S) , ijj-aV- T/'O^f/Z-oo? J LEGAL DESCRIPTION I l_-^ LCteytime F4ione No. r7 r Initial Mailing AddressLast Name First fun boY yi L( U( I K ^ t ^4 i^A r\Property Owner ViyrA^/77w 7k (Cjr \ 7/-« t Lqi^/ 70 cJJr 170Contractor Lie.#Qoi ONSITE WATER SUPPLY (V^ndividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM PROPOSED PROJECT (1) New Dwelling (4 ) MHA'R (7) Add’n To Non-Dwelling T (please circle t^^^^roprlat^umber)((^T^dd’n to Dwelling ^ (3) 'Replacement Dwelling ( ) Permit No. ** - ( )OTLSD* * This permit is only valid after verification from the O.T.L.S.D. that a contorming sewage system will be installed to service this lot contact Rotiie Mann at 864-5533. (6) Detached Garage (9) WOAS (5) RCU/Year. (8) UtllltW^tg I r i ft ^ / ^ ^ 1no) pther ! V ” LA y ^Existing Dwelling to be removed before CHARACTERISTICS OF PROPOSED DWELLIHG Structure jCtiARACTERISTICS OF PROPOSED NON-DWELLING CHARACTERISTICS OF PROPOSED WOAStf SOutside Dimension Setback to Lotline Setback to Right ot Way Setback to OHWL ~j S ^ F'- Elevation Above OHWL 3 Ft. Setback to Septic Tank I f) Ft. Setback to Drainfield ^ O Ft. Setback to Bluff /-i ' A Ft. Maximum Proposed Height Basement_____ Walkout Basement Total Bedrooms Outside Dimension Setback to Lotlin'&. Setback to Right of Wqv Setback to OHWL___ Elevation Above OHWL Setback to Septic Tank, Setback to Drainfield _ Setback to Bluff_____ Outside ^Dimensionli,^ Setback to Lotfihq ___ Setback to Right olvfay Setback to OHWL Elevation Above OHWL. Setback to Septic Tank . Setback to Drainfield__ Setback to Bluff_____ Maximum Proposed HeightFt ( ) Boathouse ( ) Screen Porch ( ) Utility Structure . I ^^Ft. X 60 3 Ft. X Ft.",Ft."_ Ft.& S^O Ft." Ft."Ft. XV Ft."Ft.&Ft.&Ft." Ft"Ft." -for Ft. Ft. Xt Ft.Ft. \ Ft.\ Ft. 3^Ft.Ft.Ft. NoYes Ff!Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) NoYesNo noI1 ■ / .. ( ) Gazebo Project/Lotlines/Right-of-ways Must be Staked Onsite Spoil Disposal ■ ^ <4 □ Onsite (scale drawing required)' ' **Project/Lotlines/Right-of-ways Must be Staked Onsite Grade/Fill/Excavation ■j □ Yes (scale drawing required) □ Offsite □ Within Shoreland Area □ Outside Shoreland Area ''pt^o ;CHARACTERISTICS OF LOT: VII 3 ,m Bluff Onsite..Yes NoSq. Ft. Water Frontage ) / i(7 Ft,Lot Area. .77 A'7'innTotal impervious Surface Onsite (FT^) 7 = 7^'j .%impervious Surface Ratio' 'j X100J Total Lot Area(FTn 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 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 Ownta Date: rce/^anagerrte^t OWceU i —^RECEIPT NO. ' ^ Of U----Land & Resou PERMIT FEE $ Project/Lotlines/Right-of-Way MUST be Staked Onsite Prior to Submission of Application.Comments: q.iyaj i 3 77M1i 301.934 • Victor Lur>d««n Co.. Printers • Forgus Foils. MN • 1-800-346-4870Form No. BK — 0500-002 SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations \ Structure Set Back from Ordinary High Water Level Ft. Structure Set Back from Top of Bluff Ft.Ft. (Po -f-Structure Set Back from Road Right of Way Ft.Ft. / ^ /—Ft. & Ft.Structure Set Back from Lot Lines Ft.Ft. & C3 /CStructure Height Ft.Ft. Structure Set Back from Septic Tank Ft.Ft. J/Structure Set Back from Drainfield Ft. Ft. Elevation Of Lowest Floor Above Ordinary High Water Level 7 7^Ft.Ft. Land Slope at Building Site % %\ Inspector's Comments / Sketch: CJ a a C4 Inspectors Signatu Date of Inspection Time of Inspection / yect Approved >Date / InitialI ^ feet//inch(es) equalsfeet, orScale: _i .grid(s) equals r yi/loA cLst $ l/i lXooo Dated Please use this sheet for the required scale drawing of your proposal. Be sure to include lot dimension, water frontage, and setbacks from RW, lake, sideyard, sewage system, top of bluff and existing structures. Required impervious surface coverage calculation (See definition in Shoreland Management Ordinance) Signature 57/8310 . %Hso % ,X 100 =)Total Lot Area (FT2) Total Impervious Surface Onsite IhJCujCt^S (FT2)r 1 f-'" - It :r 'T JJ?'7 .1^-j.-_!1 •<iiC ! t g t^ V>5 i1 ?■ « IM!a' 'T-I o DID£3b.V\f -e 7^o-t (ArS' tr!> N■-}- :r-Nto .. N§ X\Ca \7T Ne>I f I•' ''1 ; ff'-sl^-.rz-j) N CO r.o 1 IN ^ b NC5 .sy~\ a'-O HqV iQi, (B -t.:+-^ r-- i-.—■I'"T ■^rO~7 J.r^'7^ B9 -/Sf X- ^ n :1 j 1 •800-346-4870296.179 • Victor Lundaon Ca. PfinttfS • Fergus Fals. MN •1BK — 0599 — 029 i± White - Office Yeiiow — Owner 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 V' 25EEu r ^ Permit No..LEGAL DESCRIPTION AND LOCATION OiA T^// TWP NameTWPRangeLake No.Lake Classif.Sec.Lake Name IDENTIFICATION: Please Print All Information Zip No.Tel. No.Last Name Mailing Address— No. Street. City and StateFirstInitial .A % 171/9c -Owner 1-3/^5 NameContractor Architect Name. TYPE OF IMPROVEMENT;RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE: r06T 0 U^- DIMENSIONS: I ) New Building (\XOne Family Dwelling ( ) Multiple Dwelling Specify Alteration Units ( ) Other ( ) Other Size ESTIMATED COST OF IMPROVEMENT $ PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL: ( ) Masonry Wood Frame ( ) Structural Steel ( ) Other — Specify I ) Public Individual Septic Tank, etc. WATER SUPPLY: ( ) Public Individual Well Basement: ( ) Yes Stories above basement; Sq. feet (outside dimension) Bedrooms ..............................Baths X T k Type of Roof: CHARACTERISTICS; :?5l.square feet.Water frontage is feet.Maximum depth of ILot Area is ... 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 way.... Side yard is .......jX.CrJ?......... and............. Structure will be located .. feet. (Building Line) feet S.O.feet — from road right of way is .feet. feet. ..................feet from septic tank (Sewage System Permit must be obtained before installation). feet from soil absorption system (Cesspool, Drainfield, etc.).c<::2Structure 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 STATUES.nSi^ature 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 respegts to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances,,^'" ■ Dated ^ Shoreland Manaq^perft O^ficiai X Permit Fee $. Comments; 195676(^ VICTOR LUNDEEN CO.. PRINTERS, FERGUS FALLS. TForm No. MKL-0771-002 White - Office Yellow — Owner Pink — A«si^sor Goldenrod —' inspector SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone; (218) 739-2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT }1 Permit No____LEGAL C'u c.DESCRIPTION / AND LOCATION //TWP NameTWP RangeLake Classif.Sec.Lake No.Lake Name IDENTIFICATION: Please Print All Information Last Name Initial Mailing Address— No. Street. City and State Zip No.Tel. No.First Owner NameContractor Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE; ( ) New Building ( ) Alteration ( ) One Family Dwelling ( ) Multiple Dwelling Specify:. Units ( ) Other I ) Other Size ESTIMATED COST OF IMPROVEMENT $ PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL;DIMENSIONS: ( ) Masonry ( ) Wood Frame I ) Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public (. ) Individual Well Basement: ( ) Yes (-) No Stories above basement: Sq. feet (outside dimension) Bedrooms ..............................Baths Type of Roof: CHARACTERISTICS: Water frontage issquare feet.feet.Lot Area is Maximum depth of lot feet. Building set back from high water mark is.................... Land height above high water rrtark at building line is Building set back from State highway right of way..... Side yard is ..................... Structure will be located feet. (Building Line) feet feet — from road right of way is .feet. and feet. .feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.).Structure will be located Agreement; I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUES.Signature of Owner Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit: express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated Shoreland Management Official Permit Fee $. Comments: 195676® VICTOR LUNOCEN CO.. PRINTERS. FERGUS FALLS. MINN.Form No. MKL-0771-002 A INSPECTOR'S CHECK LIST Make all measurements and computations ACTUALIS X MINIMUM Shall Be Sq. Ft. Lot Area (Square feet)St-.Ft,Sq. Ft. Water Frontage Ft.Ft. Building Set Back from High Water Mark Ft.Ft. Building Set Back from State Highway Ft. 50 Ft. Building Set Back from Street or Road 40 Ft.Ft. Side Yard &&Ft. Ft. Rear Yard Ft.Ft. Occupied Building to Septic Tank Ft.10 Ft. Occupied Building to Absorption System Ft. 20 Ft. Elevation at Building Line above High Water Mark_____________Ft.3 Ft. Inspector's Comments: Inspector's Signature Title Inspection Dated 19 Agency V1CT0I LUttOCCM 1 M MINTfll*. PC*l«Ut PM.LV. HIMN. I Lp' cc>^s'Vv pc A C.V^ V'<c s~n~ s-s^ /c^ C o r\ s 4" o' CL- Vn ■^fcr 5?JO avi^l' Vys tr 7 rod (X. d'^ 4 I ■ jljij 4Ji<Wv AC GRID PLOT PLAN SKETCHING FORMfeet/inchesScale: Each grid equals Ayl.-y'L^ - - 5^219X5 ■Dated: 7 Signature Please sketai your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. ^7. s ' i V IO% ' '3 y./0'p-><4- NS / So ''•7.£;> I-------\ 3 k! AI -?V.5 6I I / 3o ' r$ V4/ ' 15’ L A K £ 21598 7®MKL-0871-029 VICTOR LUNOeCN CO . PRINTERS. FERCUS FALLS. HiNN Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 ■iv MALCOLM K. LEE, Administrator May 29, 1985 Ms. May Dobbs 6421“5th Avenue South Minneapolis, MN 55423 Dear Ms. Dobbs: On Monday May 20, 1985, an Inspector from this office looked at your property to verify that construction on your addition was halted pending a variance from the Otter Tall County Board of Adjustment. At that time construction was near completion. Please contact our office before June 7, 1985 to resolve this matter so legal action will not be necessary. Sincerely, , Brian Krawlecki Inspector apk SHORELAND MANAGEMENT ORDINANCE - DIVISION OF EMERGENCY SERVICE - SUBDIVISION CONTROL ORDINANCE SOLID WASTE ORDINANCE SEWAGE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY PLANNING ADVISORY COMMISSION RIGHT-OF-WAY SETBACK ORDINANCE FUEL AND ENERGY COORDINATION