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Home My WebLink AboutDavick-Halfen_25000280179005_Shoreland Permits_ (2)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 TAIICOflTY-aiiAItOTi Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. /LAKE / RIVER NO.LAKE/RIVER NAME SECTIONLAKE/RIVER, CLASS y TWP NO.TWPNAMERANGE///y b /-hi PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS s^srr LEGAL DESCRIPTION ^.Oi /4c/*c, PT" ^ tSCH Lj 9“ cciT t o£\r n> Aj^ — ,/ / zso n^oo^ >c.DEVELOPED j S (oi ^(JT ^ L/C S'n)UNDEVELOPED Last Name First Initial Mailing Address Daytime Phone No. 339-4 Si6-J^GvProperty Owner gT »4 VV3^/ 4^//^ Dx. wk-Contractor Name Lie. # ?;zo-;84^73fc ^C-ir\ .<1 . /?<_ fivs* PROPOSED PROJECT (please circle the appropriate number) y' ^jAdd'n to Dwelling/Altached Garage (3) Replacement Dwelling* (6) Detached Garage (9) W.O.A.S. ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt, 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ( ) L&R Cert, of Compliance within 5 yrs. (X) Compliance Inspection Report within 3 yrs. (Attached) ( ) OTWMD ‘Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rome Mann at 218-864-5533 (I) New Dwelling ( 4) MH/YR____ (7) Add’n To Non-Dwelling ( 8) Storage Structure (10) Non-Conf. Replacement (identify)"______ (II) Other (identify)____________________ (12) Deck__________________________ (13) Fence_________________________ (5) RCUA'ear ( ) 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) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Outside Dimension Sq. Ft. VLU Setback to Lotline / f Setback to Right of Way _ Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level Setback to Septic Tank 'iy Ft. \/ Setback to Drainfield Ft. ^ Setback to Bluff • Total Bedrooms Maximum Proposed Height Roof Change Yes ( ) No Basement ( )Yes C><)No Walkout Basement ( ) Yes (side profile required) ("Xf No CHARACTERISTICS OF PROPOSED NON-DWELUNG Outside Dimension Ft. X Ft."Ft. X Ft. X Ft.** jq.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 Root Change ( ) Yes ( ) No Bathroom Proposed ( ) Yes ( ) No 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 **Proiect/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.&Ft."Ft.&Ft.** Ft.**Ft.**Ft.Ft. Ft. Ft.Ft.Ft.Ft.Ft. /Ft.Ft. Ft.Ft.y ( ) Screen Porch ( ) Storage Structure Topographical Alteration / Earthmoving □ None □ 20 Cubic Yards or Less * Must include on scale drawing, additional Permit may be required.* ✓j^^l Cubic Yards - 999 Cubic Yards*□ 1,000 Cubic Yards or More* /-i/. 7/fc 2.9^0CHARACTERISTICS OF LOT;Sq. Ft.Lot Area,Water Frontage Ft.Bluff ( ) Yes {\^) No St.% 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. /y Signatu^qf Pror^rty Owner / Agent for Owner J (lX>. I & Referee Management Official j y PERMIT FEE $ - Date: Date: PROJECT(S)TOTAL SQ. R. \\RECEIPT NO. * QuaCfpiA-i Ssf prto ^ S c./o^p11 11 \jo\W yu^AA)ytj 4ti Q(^.aA>vvVvL*li4<- -\i\J ^ Date StampComments: scAt:?:ED L&R Initial[^isralForm No. BK — 04-2014 3S4.2S2 • 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-tall.mn.usw WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) uOTTCR TflIICOViTY-aiiAIIOTt Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWPNO.RANGE TWPNAME/✓ •/j/eL> PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS v// Z80 JTfoor LEGAL DESCRIPTION O/ /icrt, 6-/. Ytj/i. ^c>T > <i>A»Ac«»c<0 /Sctf UJ 9' '^y /I/vf Luf t -r.i yj VC,DEVELOPED ^ D6G'£' S94f f'o CM UNDEVELOPED. Initial Daytime Phone No.Last Name First Mailing Address AJt rC.i4UX//JProperty Owner S^c>3 vr"iT /*c O'-:^Contractor Name Lie.*sre^ssti^c,(^Z9S/2 wPROPOSED PROJECT (please circle the appropriate number) ^ (.^Add'n to Dwelling/Attached Garage ( 3) Repiacement Dweiling* ( 6) Detached Garage (9) W.O.A.S. ONSITE WATER SUPPLY ^ Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ( J L&R Cert, of Compliance within 5 yrs. (K) Compliance Inspection,Report wjltyn 3 yrs. (Attached) ’ ' ( ) OTWMD 'Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rome Mann at 218-864-5533 {1) New Dwelling (4) MH/YR____(5) RCUA'ear______ (7) Add'n To Non-Dwelling (8) Storage Structure (10) Non-Conf. Replacement (identify)''_______ (11) Other (identify)_______________________ (12 ) Deck______________________________ (13) Fence_____________________________( ) 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)CHARACTERISTICS OF PROPOSED NON-DWELLING 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 y Outside DimensionFt. X Ft.“Ft. X Ft." Ft. X Ft."7‘ ;1'>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 Roof Change ( ) Yes ( ) No Bathroom Proposed ( ) Yes ( ) No fy"Zi Sq.Ft. Setback to Lotline ____ Setback to Right of Way Setback to Ordinary High Water Level ___ Elevation Above Ordinary High Water Level Setback to Septic Tank___ Setback to Drainfield____ Setback to Bluff________ Maximum Proposed Height ___Ft. & ! Ft.*; Ft. Ft.t^ Ff.&Ft."Ft."Ft.& Ft."Ft.” Ft. Elevation Above Ordinary High Water Lev^ Setback to Septic Tank JC? Ft. V Ft. Ft.Ft. Ft.Ft.Setback to Drainfield Setback to Bluff___ •* Total Bedrooms Maximum Proposed Height Roof Change (2^) Yes ( ) No Basement ( ) Yes (X) No Walkout Basement { ) Yes (side proff/e required) (~X) No Ft. Ft.Ft.IL 9*^ Ft. ^Ft.Ft. Ft.Ft.J ( ) Boathouse ( ) Gazebo ( ) Screen Porch ( ) Storage Structure ;> ■<**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection V \ ' 21 Cubic Yards - 999 Cubic Yards* * Must include on scale drawing, ' additional Permit may be required. Topographical Alteration / Earthmoving □ None □ 1,000 Cubic Yards or More*□ 20 Cubic Yards or Less * '-i/y PCCHARACTERISTICS OF LOT:Sq. Ft.Ft.Bluff ( )Yes l,.- )NoWater FrontageLot Area. ■I:.%.%a 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. /,/ Sianatum^f Pn^rty Owner/Agent ^ Owrmr / UDate: / L LADate:\ Land & Resource Management Official j V\ PROJECT(S) TOTAL SQ.FT, ll Jo 'PERMIT FEE $RECEIPT NO. * g:)vv;pl 11 V-i: C i/0()M ^ lo'i i^ (^(ij -h) € I n Comments: fl^isra»lForm No. BK -04-2014 3S4.252 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota •k SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations 6 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.&Ft. Structure Height Ft.Ft. Structure Set Back from Septic Tank Ft. Ft. Structure Set Back from Drainfield ^0 ^Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level J-i-Ft. Ft.\ Land Slope at Building Site %% Inspector’s Comments / Sketch: Inspector’s SignsUdfe Date of Inspection Time of Inspection t^roject ADDrove<f'^ Date/lniti. IMPERVIOUS SURFACE CALCULATION List & identify all existing & proposed onsite impervious surfaces on scale drawing. 7-/-/VLot Area (ft^):Signature:Date:7 Other Impervious SurfaceBuildings ProposedExistingExistingProposed Ft^Ft^Ft^Ft K— Lr:..!21^9,7c5Deck(s)Dwelling ycQ- Patio(s)/SuAttached Garage Sidewalk(s)Detached Garage Storage Shed Landing(s)CODriveway(s)WOAS Parking Area(s)RCU C' A / Miscellaneous/?^ _____________Opcfy Retaining Wall(s) Landscaping (Plastic Barrier) % Miscellaneous 'X/CXp "7/Vo 3TOTAL OTHERTOTAL BUILDINGS Buildings Impervious Surface Percentage Maximum Allowable 20% Lot Area Impervious Surface Ratio TotalExisting Proposed Ft^Ft^Ft^Ft^Total Buildings 1 f^o 7^Vo 100+-i-X= Buildings + Other Impervious Surface Percentage Maximum Allowable 25% Total Lot Area Impervious Surface Ratio Total Buildings + Other Impervious Surface Existing Proposed Ft^Ft^Ft^Ft^ w,n<^ ---------------------------------------------Irrfpl^i^i^Psurface Calculation Worksheet 03-25-2014 ly 100+-r X !iIjI I1 SCALE DRAWING FORM' ' ' I.............................. ‘ -----(- I II I t1 R -S" ^ go c>o^s'---i rTax Parcel Number(s)1J 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). ). \ LJ, nf1ScaleI 1 i IIIII (I I I.I Ii ,_lJ I II I I,1 1I;II I IiII 1r1I IIII \J-J.T If.1 III !I )!I I 1 1 I'!I I !i.) I V.J.^_T !1I J f 1 I jI1'-j.1 II;I ]I 1 I I I I1 I I I1I I ;I i-.1 ■ -f !■h_!I r nrI 1 I I 1 I:II 1j I I „ii,_J. rr ]III i IIIiIIII I I1I 1I:1 4I I ,Li J.1. I )!I !I I1 II. IIiIII 1;J.,j. III i IiiiII 1 I I IIiIj 1 IIi1I I (t I .1.1 1IIi I.J 1i 1 ;-.-I1 I I I.I !I I I1 !!1 III1IiI I.__1 J III1 1i Signature of Property 6wner‘ • • ■ r I I Date .1II 4J1BK — 03201ft Fergus Falls. WN -• l-BOO-346^87035d,120 * Vicioi Lundeen.Co, PrintersI I / \\1 •• I ! V-V--! CrI ANDREW TUCKER & BEVERLY HANSON ni * <,//'i/ . / -/ ■-tf APPLICATION FOR GRADE & FILL PERMIT LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us Permit No.PLEASE PRINT OR TYPE ALL INFORMATION LAKE/RIVER #LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP. NO.RANGE TWPNAME ^i/o^ r PARCEL NUMBER(S)PROPERTY (E-911) ADDRESS _ —___LEGAL DESCRIPTION ^7- ,OlJ Coi*- CoT I ^kc^h U GG. 9 ' 'S'?. J J' /u 22 cG 3<J 4? 1 / ?9ooS'UC7 'XL /S 0<r<. £ S9/.S' 71, ix^kc. SlUx? ^ Last Name First Initial Mailing Address DAYTIME Phone No. /»/£__________ Ci i4lf fc;tJ<^LL :sv ir' Property Owner Contractor Name Dr. Lie.# Date Stamp NOTES: 1. The lotlines and project area(s) must be staked. 2. If project disturbs more than 1 acre of land you are required to obtain a General Storm Water Permit from the MPCA. L&R Initial PROJECT REQUEST (You may use the grid on back for required scale drawing): DESCRIBE YOUR PROJECT(S): Ao rXo 'Go fvc/uiAU/i WlcvXuI r 1 DETAILED INFORMATION: AREA TO BE CUT/EXCAVATED:Ft. X 2.0 Ft. X .7 Ft. - 27 = Yds" Ave. DepthLengthWidth m = uffi Yds"WALK-OUT BASEMENT PROJECTS: (Outside of the building foundation) Ft. X Ft. X Ft. - 27 Length Ave. Depth 30 Ft. X GkO Ft. X > Ft. - 27 = 2d Ave. Depth Width Yds"AREA TO BE FILLED/LEVELED: Length Width 75" Yds"TOTAL EARTHMOVING REQUESTED = I Ft. Max. Depth 2BACKFILL AT FOUNDATION:Ft. Distance From Foundation CULVERT:If Yes, must indicate size and location on drawing. Yes IIMPERVIOUS SURFACE:Existing %Proposed /J/7/^ Scale Drawing along with detailed impervious surface calculation must accompany this Application. SIG^TURE OF PROPERTY OWNER/AGENT FOR OWNER BK082013^ r 0\jj'\W DATE RECEIPT NUMBER I I '!I I The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/Jor proposed structures, septic.tanks, drainfieids,'lotlines, road right-of-ways, easements, OHWLs, wetis,-wetlands, topographic features (i.e. bluffs); and onsite impervious surface calculations. ! I ; ‘ 'I'I’i" ^ S i \j IiScale 1 I1I iI!1 i t 1 .J____ I I 1I !!II I( f ; FallIVictor.BK — 0209 352,19<1 •Lundeen Co., Printers • Fergus s. MN • 1-800-346-4870L . .;t Grade & Fill Permit #1950 PROPERTY OWNER !<<•'» s LAKE NO..S<^-3oZ.SEC. TWP. NAME gV£g-T~% LEGAL DESCRIPTION: fT C 3 pU-h z^ooo -'2JS' -0I ^ ■1-*^ p s <y‘i V y T=^lU Jlwtf'l-i WORK AUTHORIZEdQL?/p ile >o ^roi^K CJU. V^'iWsV^^ *POi/*CL<N. .r«|fv\o yv Qa^ \c IfcVCc - Rq.wwo O ft tg. hc*»X>*^ Wo*vV 1^0v^-SA • ^[<»\,OL, , dusi ^Ok.wd p^kQI—V<»^ -f-ra'i ( .^ >fL.V c> ( ^ rv>.vA.\c_V\ \ ^ O VN ^ vjet •yvv*-YOV»«.>yN NOTE; This card shall be placed in a conspicuous place not more than 4 feet above grade on the premises on which work is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MAN AGEMENT. 218-739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED. 1. EARTHMOVING SHALL BE DONE BETWEEN & S-t-^Sr 2. Entire area shall be stabilized within 10 days of completion of any earthrhoving. 3. Owner is legally responsible for all surface water drainage that may occur. 4. No fill shall enter or be taken from the beds of public water without a valid permit from the MN Department of Natural Resources. 5. If the terms of this permit are violated, the entire permit may be revoked and the owner may be subject to legal prosecution. WHITE-Offica GOLDFNROD - Inspector YELLOW - Owner PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone:(218)739-2271 • FERGUS FALLS, MN 56537 Permit No.LEGAL DESCRIPTION CrLi 3^0 /BLUFF ZONEAND □ YES |3>N0 LOCATION LAKE NUMBER LAKE/RIVER NAME SECTIONLAKE/RIVER TWP NO.RANGE TWP NAME &b-3o3i /^3 4^ PARCEL NUMBER (S)GRADING / FILLING FIRE NUMBER- )n^ YES■4.5- 4X0 -.2^-0/ 79- oas # OF CUBIC YARDS Q NO (U'ndM/ IDENTIFICATION: Please Print All Information TELEPHONE NO. Last Name First Initial Mailing Address — No. Street, City, State, and Zip Code (Daytime) Property Owner ~n^rJ /9v< ■Pir^ifie ^ fYI>Aj S6 3»7 SelfNameContractor State Lie. # PROPOSED PROJECT t^) New Structure(s) ( )Addition(s) ( )MH/RV______________ PROPOSED USE ( ) Dwelling ^ Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ^Individual Permit #___ ( ) Collector Permit #_____ ( )OTLSD*YEAR CHARACTERISTICS OF NON-DWELLING ( ) Detached Garage CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING ( ) Utility Structure ( ) Boathouse ( ) Screen Porch( ) Dwelling ( ) Replacement Dwelling Addition to Dwelling ( ) Existing Dwelling shalljte removed on or before. Outside Dimension. ( ) Basement ( ) Walkout ( ) Attached Garage ( ) Gazebo ( ) Utility Structure( ) Other Outside Dimension .Ft. X .Ft.( )Other. Outside Dimension.Ft. X .Ft.Lotline Setbacks Ft.&.Ft..Ft. X .Ft. /O Ft. & /Or.Lotline Setbacks OHWL Setback .Ft. Lotline Setbacks Ft..Ft.&/ooOHWL Setback .Ft.Bathroom: ( ) Yes ( ) No (If Yes / a complying Sewage System Required)IL OHWL Setback .Ft. Total Bedrooms Maximum Ft. (2 story)2 Maximum Height / 10 ft. (1 story)Maximum Height Ft...story ID .Sq, Ft. Impervious Surface .Sq. Ft. Impervious Surface Ratio .%Lot Area .Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage .Ft. Slope of lot .%Structure setback to right-of-way____________ Structure setback to septic tank_____________ Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System 10 .Ft. (10’minimum) (Sewage System Permit required before installation). Ft. (20’minimum) (Sewage System Permit required before installation). .Ft. (10’minimum) (Sewage System Permit required before installation)./D THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. * This permit is only valid after verification from the O.T.L.SD. that a conforming sewage system will be installed to service this iot... Contact Rollie Mann at 864-5533. Dated: Sign^ure of Owner Dated: Land & Resource Management Office - PERMIT FEE $RECEIPT NO. I - I9i‘ __________ -tf ^ ^ ]^jM/Ay(ju^azC£idiJj ^^ 3____ Form No. BK 0597~l^n Victor Lundeen Co . Pnm«rs • Fergus Falls MN • 18^0 346 4870 Lj Comments: i ■ V APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE - Office GOLDENRQP - Inspector YELLOW^ Owner PINK’- Assessor Permit No.LEGAL DESCRIPTION 3^0/ &BLUFF ZONEAND□ YES [3^N0 LOCATION LAKE/RIVER NAME LAKE/RIVER CLASS c SECTION TWP NO.RANGE TWP NAMELAKE NUMBER \ : Au I \J 16A A /Q /■^ I. GRADING / FILLING 0( YES # OF CUBIC YARDS □ NO FIRE NUMBERPARCEL NUMBER (S) i-Aj-- }0 IDENTIFICATION: Please Print All Information TELEPHONE NO. Mailing Address — No. Street, City, State, and Zip Code (Daytime)First InitialLast Name Property Owner H.Tk,A Ar - P,r-f /^» /Qa »i«a ■ 3y; s:/fNameContractor State Lie. # ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE; MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ^Individual ( ) Collector Permit # ( )OTLSD* PROPOSED USE ( ) Dwelling ^ Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) PROPOSED PROJECT ( ) New Structure(s) ( ) Addition(s) ( )MH/RV______________ Permit # YEAR CHARACTERISTICS OF NON-DWELLING ( ) Utility Structure CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING ( ) Dwelling ( ) Replacement Dwelling ^Addition to Dwelling ( ) Existing Dwelling shall be removed on or before Outside Dimension. ( ) Screen Porch( ) Boathouse( ) Detached Garage( ) Basement ( ) Walkout ( ) Attached Garage ( ) Gazebo ( ) Utility Structure( ) Other Outside Dimension 1I.Ft.( )Other. Outside Dimension Ft.x A .Ft. X .Ft..Ft.Lotline Setbacks .Ft.&Ft.Ft.x /O Ft. & /OLotline Setbacks Ft.OHWL Setback .Ft.&.Ft.Lotline Setbacks .Ft.OHWL Setback Bathroom: ( ) Yes ( ) No (If Yes / a complying Sewage System Required)Ft.OHWL SetbackTotal Bedrooms Maximum Height / 35 Ft. (2 story)Maximum Height / 10 ft. (1 story)Ft.Maximum Height story o / A•%.Sq. Ft. Impervious Surface Ratio.Sq. Ft. Impervious SurfaceLot Area A3<7- /O Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage cAc6 .%Ft. Slope of lotStructure setback to right-of-way. 10 .Ft. (10’minimum) (Sewage System Permit required before installation). .Ft. (20’minimum) (Sewage System Permit required before installation). .Ft. (10’minimum) (Sewage System Permit required before installation). Structure setback to septic tank_____________ Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System THIS IS A SITS PEHI4IT ONLY AND DOSS NOT CONSTITUTE A BUILDING PERMIT « SET FORTH IN CHAPTER IS, MINNESOTA STATE STATUTES, Agreement; I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. * This permit is only valid after verification from the O.T.L.SD. that a conforming sewage system will be installed to service this lot... Contact Rollie Mann at 864-5533.I - ? - V k-I Dated: !Signature of Ownera5 -Of // )Dated: Land & Resource Management Office iioo6o'So•J / RECEIPT NO.PERMIT FEE $ 4k) I- V X tSi C,' X y j /'• m'gj%Comments: i, // 'f h/7- <L ■■A S-i - 290.821 • Victor Luodeer* Co . Printers • Fergus Falls. MN • 1-800-346-4870Form No. BK — 0597-002 INSPECTION RESULTS 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. \0 Ft.&<^^ Ft.Structure set Back from Lot Lines Ft.&Ft. W 2. ^fOY^Structure Height Ft.Ft. II'Structure Set Back from Septic Tank Ft.Ft. Structure Set Back from Absorption System Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level____________________Ft.Ft. \0^hLand Slope at Building Line %% Inspector’s Comments / Sketch:, it? r'A^io^.y n* --Ta-nT tp ft, l*:i- prol e J /C 7.(7° CA-f I \\\n rn}—Li y \ Date of liN i Tuneofli CJCD V- a.0. 3 I!!ie !1.3" * Cx;ST'.**-c i■; ‘c ili.b ICD»1 '|ji itliJ 7< pucri 11 ■; ■ 'rtiutirti gLi>6 in soCD\0 00 lO fw 00 ■ ■! X'™4?%\-•1 ‘ !eg I DCi^<,. ii' p«w^U K It' pttx.t'« It CtltJt. £jurr*»c-.H o 't C^rjr.^ -^^eew 7««r I is-c ■> gc «c "M I^D 00 \ CM circle/\^ G ^ UhO S> c^' ;r )fe‘C *»P7/V«^C W' / J s4r‘^t U-t J5-U.j ( v-^uw i<yf'= ■ V APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WH/TE — Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor Permit No.LEGAL P^. G L 3DESCRIPTION AND 3, OfLOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME y s/3 3 •e ^iPa PARCEL NUMBER (S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and StaleLast Name First Initial Zip Code Telephone No. [htu ( C l4(^ f-s ^O' e.Property Owner _____Kpus e V"/ 'yi 0 7^ Name 0Contractor State Lie. # PROPOSED PROJECT ( ) New Structure ( X) Addition ( ) MH/RV PROPOSED USE RESIDENTIAL USE NON-RESIDENTIAL USE ( ) utility Structure CHARACTERISTICS OF PROPOSED ) Residential ( ' ) Non-Residential ( ) One Family Dwelling ( ) Multiple Dwelling # of Units ( ) ' Basement ( ) Walkout Basement ( Outside Dimension of Structure________ ) ) Water Orientated Accessory Structure( Xj) other Jo # Of Stories______ (Ft.YEAR yp Ft.TYPE OF FRAME ( ) Masonry (^ ) Wood ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM ( ) Public ( Vi) Individual h Permit # ru / ( ) OTLSD ONSITE WATER SUPPLY ( ) Public ( Y) Individual { ) None OFFICE USE ONLY ) Bluff Impact Zone ) Shore Impact Zone ) Sensitive Area (# Of Bedrooms (# Of Bathrooms { LOT SIZE AND SETBACKS: Lot Area is square feet. Water frontage is feet. Maximum depth of lot feet. Building set back from ordinary high water level is feet. (String Test) 3Land height above ordinary high water level at building line is feet. Slope of lot % Building set back from road right-of-way.feet. /OLot line setback is and feet. /c?Structure will be located feet from septic tank (Sewage System Permit must be obtained before installation). Structure will be located.feet from soil absorption system (Sewage System Permit must be obtained before installation). 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. /6- 3Dated:e Sigrfature of Owrrer Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. Thi^'^permit is granted upon the express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. 7/ )o - 3Dated; Land & Resource Management Office 'So.//^ / 7Permit Fee $.Receipt No. Comments: Form No. BK — 0292-002 262,316 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota ^ APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE Office GOLDENROD — Inspector YELLOW — Owner ^ PINK — Assessor LEGAL 'description Pk G I - 3 3. O! AND 10LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME 7^/ *>/< / -T^/O56 >/3 3Pn 7PARCEL NUMBER (S)FIRE OR LAKE ASSOCIATION NUMBERIJ \ - CCO' Of C/7^ - CO ^ i IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. K ~ hlo 0 ^^7 /IJp'c L' e.Property Owner £773 y c fi^ccP'S ^ / <»<: /I‘ 31 p / ■!Name 3Contractorf Ccj) pLli ^^7 ^ PROPOSED USE^ ^ State Lie. # PROPOSED PROJECT ( X ) New Structure ( X ) Addition ( ) MH/RV RESIDENTIAL USE ( ) One Family Dwelling ( ) Multiple Dwelling # of Units ( ) NON-RESIDENTIAL USE CHARACTERISTICS OF PROPOSED ( X) Garage 5 i(X ) Residential ( ) Non-Residential ' Basement ( ) Walkout Basement ( Outside Dimension of Structure________ ( ) Utility Structure ) ) Water Orientated Accessory Structure ( Ft.YEAR yp Ft.( >(^) other , ^ , 'x//TYPE OF FRAME { ) Masonry (X" ) Wood , ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY ?■Height of S^^cture. # Of Stories_____1 # Of Bedrooms __ { ) Public ( y ) Individual ( ) None OFFICE USE ONLY ) Bluff Impact Zone ) Shore Impact Zone ) Sensitive Area ( ) Public ( V) Individual X ^ Or Permit ff_JA—L((It Of Bathrooms ( ) OTLSD ( LOT SIZE AND SETBACKS: Lot Area is square feet. Water frontage is feet. Maximum depth of lot feet. Building set back from ordinary high water level Is feet. (String Test) 3Land height above ordinary high water level at building line is feet. Slope of lot % Building set back from road right-of-way.feet.1 Lot line setback is and feet. /(9structure will be located .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. 3 .rP.Dated:-f-7SigfiaturB of Owner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon the express condition that the person to whom it Is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. !r 7 3JODated: Land & Resource Management Office / f. - O—Receipt No. / /X / >Permit Fee $. Comments: Form No. BK — 0292-002 262,316 — Victor Lundeen Co., Printers, Fergus Falis, Minnesota i. ..INSPECTION RESULTS Make all measurements and computations ACTUAL MINIMUM Sq. Ft. Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft.Ft. J-av f-/5MBuilding Set Back from High Water Level Ft.Ft. Building Set Back from Top of Bluff Ft.30 Ft.t 5-t f-5or 20Building Set Back from Road Right of Way Ft.Ft. Building Set Back from Lot Line Set Back Ft. &Ft. Ft. r5L iZBuilding Height Ft.Ft. H'<rBuilding Set Back from Septic Tank Ft.10 Ft 3.C2rcBuilding Set Back from Absorption System Ft.20 Ft Elevation AboveHigh Water Level at Building Line /T^Ft.3 Ft. SLand Slope at Building Line % Inspector’s Comments: Sketch: / / )/ j \ \>1 \i \ - \V rs I i V \T}spector's Signature .-'6 - _>q-°i bate of inspection ./6 30 Time of Inspection