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Home My WebLink AboutDeer Lake Resort_25000050030000_Shoreland Permits_Grade & Fill Permit # 6339 PROPERTY OWNER \^v. LAKE NO.g^^f^ SEC. S~ TWP. NAME evecrs pT~ S' ^ __ V'«-%^QvV ~C ^ CL. - LEGAL DESCRIPTION; WORK AUTHORIZED s>aw<s.Wov>Ac V:>ftjVwQ-v/w. ^ Sko/<>i\rOL. Va\VK! Cy^Vq-VsB^ *\.v^ \w ■€ .qC- ^ IL *3d— Ho «^D> NOTE: This card shall be placed in a conspicuous place not more than 4 feet above grade on the premises on which wprk is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MANAGEMENT, 218-998-8095 W^EN AUTHORIZED WORK HAS BEEN COMPLETED. 1. EA<^l\/IOVING SHALL BE DONE BETWEEN 2. Entii^^ea*|hall be stabilized within 10 days of completion of any earthmoving. 3. Owne^^egally responsible for all surface water drainage that may occur. 4. No fill sfl^ ei^er or be taken from the beds of public water without a valid permif from the MN Depa^li^en^of Natural Resources. 5. If the terrr^^f this permit are violated, the entire permit may be revoked and the owner may be subject to legal prosecution. 6. Erosion control measures must be implemented prior to any topographical alterations. f 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 V Permit No.PLEASE PRINT OR TYPE ALL INFORMATION LAKE/RIVER #LAKE/RIVER NAME /LAKE/RIVER SECTION TWP. NO.RANGE TWP NAME 5 /^3 eV£ATS rV PROPERTY (E-911) ADDRESS cP5 ooo OSoo3oZMr~—-^ ;^7oy<^ <^- &fr7Z£ paeoD frSociTO/ 39 ‘S3t 3cA£S ./SesoO- PARCEL NUMBER(S) LEGAL DESCRIPTION Last Name First Mailing AddressInitial DAYTIME Phone No. (^Se^____ S^9t^ M/J /yp-zf/e /eesc^T^Property Owner 3^-^7Se9’7 ShS70 Contractor Name Lie. # f,£COORCF-V*K!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.RECE/VlD>|]U/ MK-L4-a8yL&R Initial > '^'--SOURCE PROJECT REQUEST (You may use the grid on back for required^^le drawing): DESCRIBE YOUR PROJECT(S): U9/?5^ou.7S y?/u 7^ /i^aL ^ ff/J/e />^€^Ty .hZijA/ TZ? nrr^ -TTiJPL. Az:U-€/^. T^e /^/huyyyi/i/py a/j My^yjryu /o/ur.^ 3ufcJz gjovcoy ^iz/e6 7^> -^>c^/k7aj7dKj& DETAILED INFORMATION: AREA TO BE CUT/EXCAVATED:Yds^Ft. X Ft. - 27 =Ft. X Length Width Ave. Depth Yds^WALK-OUT BASEMENT PROJECTS: (Outside of the building foundation) Ft. X Ft. X Ft. -*-27 = Length Width Ave. Depth ^ Ft. ■*• 27 = 7~o ^,p >Yds^AREA TO BE FiLLED/LEVELED:T .'O Ft. X c-Ft. X a WidthLength Ave. Depth ✓ o'’ I I" 't- Yds^TOTAL EARTHMOVING REQUESTED = BACKFILL AT FOUNDATION:Ft. Max. Depth Distance From Foundation CULVERT:If Yes, must indicate size and location on drawing. Yes No IMPERVIOUS SURFACE:% kSIGNATURE pF PROPERTY OVyfJER/AGENT FOR OWNER RECEIPT NUMBERDATE BK062011 -/o7y9C. — c^OO X cRO 7^1^■K ^ .^zAJC/fes, 4 ¥ u\u 1.r c/re^O\cA^\0t (0^urH rH D DnT» ^ K /u/?s/^c7t^ fD.■H TJ o I f V T^Ci S&KS/«7X5 ■r' r‘ '0/ H noTJ /'ff<s I /'O^Q3■u•O Cy'&Go c^SE ^^€6I D 3 333J3 f) (SIso oL. i_ D3 n,-H ■U 3XIITJ osI >-X LAND .......ce£_ WHlT£t- Office , GOLDENRCD - Inspector YELLOW - Owner (after issue) PINK - Assessor APPLICATION FOR SITE PERMIT j 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 'safest*PLEASE PRINT OR TYPE ALL INFORMATION LAKE / RIVER NO. LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME /jtjO? <■F^D PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS CO . BAffLi /7lv.SOOS 00(^ LEGAL DESCRIPTION j.70 fic Pt &L. COfV /yic-^1^ S QPC /- s /r /j f'o/Ajr <fct First Initial Mailing Address Daytime Phone No.Last Namef P Ko^-g-lL^ 1 r10^<^7 /b ^73 C6 f-0^ Z- /hJj.Property Owner \ i i2 ■i Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) (2 ) Add'n to Dwelling (5) RCU/Year______ (7) Add’n To Non-Dwelling (8) Storage Structure (10) Non-Conf. Replacement (identify) _ (11) Other fidentitv) . " 'Existing Dwelling to be removed prior to. ONSITE WATER SUPPLY ( ) Individual (-s.) 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. OTWMD 'Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Roltie Mann at 218-864-5533 (3) 'Replacement Dwelling (6) Attached / Detached Garage (9) W.O.A.S. (1 ) New Dwelling (4) MHA'R_____ r ., TV- I i/JlorChf f <nrY~r. 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) (V ) No ' CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension iflii'r,Ft."Ft. Xi' Ft. X Ft.".Ft. X Ft."/ Sq. Ft. Setback to Lotline Setback to Right of Way Setback to Ordinary High Water Level /_ Elevation Above Ordinary High Water Level Setback to Septic Tank Setback to Drainfield / Setback to Bluff ' Maximum Proposed Height Roof Change ( ) Yes ( X) 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 **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / inspection ^ Ft." Ft." ly75 ■ Ft.& 7^ 7- X'-r Ft." Ft.&Ft."Ft."Ft.& 4-Ft."Z!___Ft. Ft. Ft.Ft. Ft.Ft. Ft.Ft.Ft. Ft.Ft.Ft. Ft. ____Ft.Ft.(^ / 5 Ft. Ft. ( ) Screen Porch ( ) Storage Structure ' Must include on scale drawing, additional Permit may be required. Topographical Alteration / Earthmovina □ None □ 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More'□ 20 Cubic Yards or Less ' CHARACTERiSTiCS OF LOT: Ft.Bluff ( )Yes (> )NoSq. Ft.Water FrontageLot Area. 9^/7- Zbc,/m Total Lot Area (FTO Impervious Surface Ratio:X100 =.% Impervious Surface RatioTotal Impervious Surface Onsite (FT^) TH/S /S A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con dition that the person to whom it is granted, and his agent, employees and 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. %-9Date:r Signature of Property Owner / Agent for Owner Ij7-/pr/o ^7Date; Land & Resource Management Office^ PERMIT FEE $ 1\ RECEIPT NO.■1PROJECT(S) TOTAL SQ. FT.. ~Y~.I Comments:!7^■7 Form No. BK — 1003-0407 329.582 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota t SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Structure Set Back from Ordinary High Water Level Ft.Ft.f Structure Set Back from Top of Bluff Ft.Ft. Structure Set Back from Road Right of Way Ft.Ft./oo /O A ^r- Ft. & -S> Ft.Structure Set Back from Lot Lines Ft. & Ft. <P/C~Structure Height Ft.Ft. Structure Set Back from Septic Tank Ft.Ft. Structure Set Back from Drainfield ^-€i T~Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft. Land Slope at Building Site %%o-Y iO.Inspector’s Comments / Sketch: f IIK I* DI li V " Inspector's Signahjn Date of Inspection Time of Inspection ^-Project Approved / Date / Initial !- a. K cQci- ++•-f 1 Ca/v .................i I AI II/ / ;Dcct u<^f^c f{esoyTh\:I ✓I eo'^r,1 '0 «L 4-VV->B I f 1i: !1 G-. I ■ \./I-• T iP! f|:J > i1I I'N .-.)1 .1 ■ oW> O ;' \i i Ll ''A : , W\ /)0,'V. \!^- .■I «t o} r -t\s\r^; iU'/•»>i t\\=V—,r»A-f.'Z VfiI i<.j \, ; 1/» J \ \>- '< ■ ;; i \ ^t \t!< 4*>^.' ^. I'i^!|!| ! ,: !T , ^ ’ !^//'I:■i Zif}1 I<5 I\ ■.I1 !<,1 I f\^o''-rf i \tI{\ 1 it<c‘I I\1 \\ \:(V;l.■ :' I . 7- (■' ■-'■.II <7^ *:i r8' Ur I 4iI B -!\1 ^ ■ O’ / / 4^-f-',■-•j -j r'<ry\ 11 i yV "'C [Vi/ '> c HiH cV'•!(> I r* A <M 'T ^ SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMIT WHITE — Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor Sch S 3V''£: ^ sr //Permit No.LEGAL DESCRIPTION AND LOCATION LAKE NUMBER LAKE/RIVER NAME ^KE/RIVER 1 lAfCLASS k'lvtr SECTION RANGETWP TWP NAME - odso^eo o S Vor3:5 FIRE OR LAKE ASSOCIATION NUMBERPARCE IDENTIFICATION: Please Print All Information ■Mailing Address — No. Street, City and StateLast Name First Initial Zip Code Telephone No. or- h^orls&>t j RK 1 Rmrr 7/Property Owner NameContractor TYPE OF PROJECT PROPOSED USE RESIDENTIAL USE One Family Dwelling ) Multiple Dwelling NON-RESIDENTIAL USE ( ) Garage CHARACTERISTICS Basement Walkout Basement Height of Structure <3O Ft. ( Residential. ( ) Non-Residential ) New Structure Alteration ( () h|hlity ^ucture ) Wa^^rientated Aceies^y Structure <x>() Other # of Units ( )( TYPE OF FRAME ( ) Masonry TYPE OF SEWAGE DISPOSAL WATER SUPPLY ( ) Public ( ^^Individual ( ) Other Outside Dimension of Structure S' rr/o „ OFFICE USE ONLY Bluff Impact Zone (^P Shore Impact Zone ((\/0) Sensitive Area •B-( ) Pubiic i<isv It Of Bedrooms(;>0 Wood # Of Bathrooms( ) Structural Steel ( ) Other LOT SIZE AND SETBACKS: KST)S', /hLot Area is sriinrn fiTt. Water frontage is feet. Maximum depth of lot feet. Building set back from ordinary high water levei is feet. (String Test) fi:S1Land height above ordinary high water level at building line is feet. Slope of lot % Building set back from road right-of-way feet. 50Lot line setback is and feet. Structure will be located .;__feet from septic tank (Sewage System Permit must be obtained before installation). agStructure 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. Signature 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. Dated: / V- 9Z,c:Dated: Land & Resource Management Office Permit Fee it. J ^Receipt No.. Comments: Form No. BK — 0292-002 260,770 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota 'T**'-T J i SHDRELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMIT WHITE —JDffice GOLDENROD — Inspector YELLOW — Owner PINK — Assessor goo' S 3V°£: of or ^5' /7?^VLEGALPermit No. DESCRIPTION AND ko i~ SLOCATION LAKE NUMBER LAKE/RIVER NAME SECTIONr- l/'XE/RIVER »ArCLASS y TWP RANGE TWP NAME ^5- OS ~ dd3 0-co c> 3 Sr /-s^CD/?3 PARCEt FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and StateLast Name First Initial Zip Code Telephone No. O t tpyQ Js j rR X 3^ 7/Property Owner X-,Le. ^65-/5 STTFNameContractor TYPE OF PROJECT PROPOSED USE RESIDENTIAL USE ( One Family Dwelling ) Multiple Dwelling # of Units ( ) NON-RESIDENTIAL USE ( ) Garage U^ty { ) Wat^^rientaled Ac^fessOry Structure ( ) Other CHARACTERISTICS Basement - ' Walkout Basement Height of Structure S^ Ft. Outside Dimension of Structure # Of Bedrooms __ ( Residential ( ) Non-Residential ( ) New Structure ( Alteration ( ) Other ( )ucture< V TYPE OF FRAME ( ) Masonry Wood ( ) Structural Steel ( ) Other TYPE OF SEWAGE DISPOSAL ( ^ 5 Public ( )r ) Individual '3 *7 "? / Permit WATER SUPPLY ( ) Public ( ^ Individual OFFICE USE ONLY Bluff Impact Zone Shore Impact Zone ((v/ 0) Sensitive Area t9- 1 # Of BathroomsI LOT SIZE AND SETBACKS:Ac r<fS squaw-feet. Water frontage isS', JhLot Area is feet. Maximum depth of lot feet. / //y£> Building set back from ordinary high water level is feet. (String Test) ?Land height above ordinary high water level at building line is feet. Slope of lot % Building set back from road right-of-way.Jeet. ' i5 0Lot line setback Is and feet. Structure will be located J__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).fkOStructure 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 Taii 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. Signature ol 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. s/q't_^Dated: Dated: Land 4 Resource Management Office ' oSPermit Fee $.Receipt No. Comments: ft • Form No. BK — 0292-002 260,770 — Victor Lundeen Co.. Printers. Fergus Falls. Minnesota .....M iINSPECTION RESULTS Make all measurements and computations . , ■ "'I i» ACTUAL MINIMUM Sq. Ft. Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft.Ft. 06^ /on //^Tior/i /ooBuilding Set Back from High Water Level Ft.Ft. Building Set Back from Top of Bluff Ft.30 Ft. Building Set Back from Road Right of Way /oo i-Ft.20 Ft. Ft. & Ft.Building Set Back from Lot Line Set Back Ft. Building Height Ft. Ft. /o-fBuilding Set Back from Septic Tank Ft.10 Ft 2^-hBuilding Set Back from Absorption System Ft.20 Ft Elevation Above High Water Level at Building Line M Ft.3 Ft. Land Slope at Building Line % •X 0//::££. J-^A/it^Inspector’s Comments: CSr^H S3 Sketch: ! I Inspector's Signature Date ot Inspections ? ■ /5 n. Time of Inspection ♦Vf SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 - Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT WHITE - Office GOLDENROD — Inspector YELLOW - 0\f/nel PINK — Assessor Permit No..LEGAL DESCRIPTION AND LOCATION lU) TyiMyuCzj£2 Range TWP NameSec.TWPLake Classif.Lake No.Lake Name fPENTlFCCATfON: Please Print All Information Tel. No.ast/Name j _______A First mmjti Zip No.Mailing Address— No. Street. City and State_____________Initial Owner Uyi^7^ -d^£nLJ/ '7 NameContractor t Architect Name. NON-RESIDENTIAL PROPOSED USE:SfDENTIAL PROPOSED USE;TYPE OF IMPROVEMENT: RE(V5 New Building ^ ^ ( > Alteration ( ) Multiple Dwelling lyi Other ti h-L Other Size /O i0 ^ ^ iLy ^ (y Yjt/UjtF^/nO JjT( ) One Family Dwelling Specify; Units ESTIMATED COST OF IMPROVEMENT $ TYPE OF SEWAGE DISPOSAL;DIMENSIONS: Basement: ( ) Yes No Stories above basement; Sq. feet (outside dimension) Bedroorhs .........C2 PRINCIPAL TYPE OF FRAME:"ors. a( ) Masonry Wood Frame ) Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public Individual Well I Baths 1)0 ...........feet. Maximum depth of lot CHARACTERISTICS: U6Q.Si>.:h Water frontage is feet.Lot Area is ... 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 .......7?^^!............. and....... Structure will be located feet. (Building Line feet ,feet.feet — from road right of way is feet. /d .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 16) months. TH/S /S A S/TE 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. XDated 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. T) , ■O -'3-^f ^T?./}T) Dated Shoreland Managen^nt Official 7Receipt No.__Permit Fee $. yCoLU/ yh /n/)Comments:' 7^17 \Form No. MKL-0286-019 229971@ VICTOR LUNDEEN CO.. PRINTERS. FERGUS FALLS. MINN.\ SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE ^ Phone: (218) 739 -2271 - Fergus Falls, Minnesota APPLICATION FOR SITE PERMI. WHITE - Office »- GOLDEMROD — Inspector YELLOW — Owner PINK — Assessor aliu-6vt Permit No,.LEGAL DESCRIPTION AND LOCATION r' /\<-i {)/ TWP NameRangeTWPSec.Lake Claasif.Lake NameLake No. IDENTIFICATION: Please Print All Information Tel. No.Zip No,Mailing Address— No. Street. City and StateInitialFirstLast Name : /r' ,4-('!/Owner I (c- //> i ^ /'/it>/■ r./NameContractor V Architect Name. NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT: (^ New Building ( ) Alteration ( ^ Other . ' / y / / T ' idChM'n £ £L 'yLwOf Ik P\ h hj \Ln\Specify:( ) One Family Dwelling ( ) Multiple Dwelling Units SizeOther ESTIMATED COST OF IMPR0VEMENT|$ DIMENSIONS: Basement; ( ) Yes (.,X No Stor ies above basement: Sq. feet (outside dimension) Bedrooms ............................. TYPE OF SEWAGE DISPOSAL;PRINCIPAL TYPE OF FRAME;ors. D.( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY; ( ) Public Individual Well ( ) Masonry ( ><J.Wood Frame I Structural Steel ( ) Other — Specify / Baths <x (................feet. Maximum depth of lot 7 CHARACTERISTICS:Li&a feet.square feet. Water frontage is 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 .......T^^............. and................................... Structure will be located Lot Area is feet. (Building Line)2 feet ..^.0..•feet.feet — from road right of way is .., feet. /n..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 prart 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. 'Signature of OwnerXDated. 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 ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Permit: / /Dated Shoreland Mahagenyint Official |(~i 7Receipt No.Permit Fee $. xL- a/- (.a xVy/// Jci (/} i ’ / xK' ^ ^ Off ^ Comments:' 'II &£ AfTJ__ /-X / 'TZ/- •>/ ! Form No. MKL-0286-019 229971®VICTOR LUNDEEN CO.. PRINTERS. FERGUS PALLS. MINN. P;, f INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS jr MINIMUM Shall Be 4-Sq. Ft Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft.Ft. 5o-6o Ft.Building Set Back from High Water Mark Ft. Building Set Back from State Highway Ft.50 Ft. )60 -f- Ft.Building Set Back from Street or Road 40 Ft. 2JTC/Z*)Side Yard &Ft.&Ft. lOo tRear Yard Ft.Ft. 5o^Occupied Building to Septic Tank Ft.10 Ft, 5oi-Occupied Building to Absorption System 20 Ft.Ft. Elevation at Building Line above High Water Mark_____________3 Ft.3 Ft. l-^OTInspector's Comments: 7 ^ Xr IDL g)f(o Kacrf /^X/4 M^rrxa^ ro(^AftAc>tS' XS CvUICc42C?/). CSfVH I nspeciof-'s-SWriaTure----- Title Inspection Dated 6>- ~2-C,^Z.19 Agency i vicrea uiMtliH 4 M.. Mtianiia. rcittus ■i«h.1- 'I r 1 Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 January 8, 1992 Deer Lake Resort R#2 Box 71 Battle Lake, tlN 56515 RE:Site Permit #10486 for lot on Deer Lake <56-298). Dear Deer Lake Resort: Please be advised that Site Permit #10486 has expired. To date our office has not been notified that your project was ready for inspection as is required. If your project is ready for inspection you should notify our office immediately, started and you still plan to proceed, you should seek renewal of your permit immediately. If your project has not yet been Please contact our office if you have any questions regarding this matter. Sincerely, 3 Marsha Bowman Office Manager SHORELAND MANAGEMENT ORDINANCE - SUBDIVISION CONTROL ORDINANCE RIGHT-OF-WAY SETBACK ORDINANCE - SEWAGE SYSTEM CLEANERS ORDINANCE RECORDER, OTTER TAIL COUNTY PLANNING COMMISSION OTTER TAIL COUNTY DEPT. OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH COURT HOUSE FERGUS FALLS, MN 56537 218-739-2271 PLAN REVIEW RECORD /OwnerEstablishment Name: Address:Address; ^ / Legal Description:Lake: i—Lodging, # Units MH, # Sites_____ Food, Beverage RCA, # Sites License Type N/A:Date: Permits Applied for (township, city, county) Department of Natural Resources approval Plans and Specifications in writing Plumbing, MDH approval Swimming pool, MDH approval State Fire Marshall approval Sewage disposal system, approval ^ - 3-9 / CHARACTERISTICS: square feet. Building set back from high water mark is Depth to groundwater Building set back from road or highway right of way is Side yard set back is Water frontage is feet. Maximura Lot Depth feet. feet.Lot Area is feet. feet. and feet. COMMENTS: The plan submitted meets the standards of the Otter Tail County Ordinance. Environmental"Health Sanitarian Date 0g e /• I'akc +4"+•+% Ca.'nff'S A h Occt U«-Kc. Reso^-T # -(■I5 - :..v. ;4-. ■ -!■ :■■ .i ^Vi\\\!if ,■■■ f 1 !i- 4-( i \s !4;I <i 1i J ;Ti! !i. -t »j i \ ¥mTliT" ^ I 1 ^4\ »i i 'ii\it JO <3 I 1 i%<I ■! ' \ HHiilili I \\f ■ i I (t (<7 i ; »4 i White - Office Yellow —• Owner Pink — Assessor Goldenrod — Inspector 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 Permit No„LEGAL <foDate.DESCRIPTION AND LOCATION THIL P\V£ft. Lake Name as_/■?3 TWP_______RangeLake No.Lake Classif.Sec.TWP Name IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address— No. Street, City and State Zip No.Tel. No. I,Owner It /f jUcf-TH tuk\XfSi.NameContractor Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE: (jAjOne Family Dwelling ( ) Multiple Dwelling ( ) Other NON-RESIDENTIAL PROPOSED USE: Specify: C Ad ^ -_________( ) New Building ( ) Alteration f^Other_______ (Units Size ESTIMATED COST OF IMPROVEMENT $(omit cents) PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: Basement: ( ) Yes No Stories above basement: ............................ Sq. feet (outside dimension) ..... Baths ( ) Masonry ( ) Wood Frame ( ) Structural Steel (y/i Other — Specify ( ) Public Individual Septic Tank, etc. WATER SUPPLY: ( ) Public (y4k^lndividual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central -Zk.Bedrooms HEATING: ( ) Electric ( ) Coal Other: jX). NoType of Roof:(><L.Gas I ) None ( ) Oil No ( ) Unit CHARACTERISTICS: Lot Area is square feet.^Water frontage is . feet. (Building Line) ................................feet feet. ...yiS®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 ...........ZIjC:CL 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. ^algW^re ojjpwner ^ d-L-Dated. Permit: 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. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the /3,^ - 1~^oDated Shoreland Management OfficialJ.OOPermit Fee $.State Surcharge $. 3^ /JoT^ - Qj zElSl JiC tAc.bCJi^ QComments: V Form No. MKL-0771-002 ,y... 158899vierea ujMOCta a eo..I Til 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 v" ^ cfoDateDESCRIPTIONi AND LOCATION - j/ {_h* TWPr-;>^ /i')■i~ Lake No.Lake Name Lake Classif.Sec.Range TWP Name IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address— No. Street. City and State Zip No.Tel. No. r, I T'/, iil91Owner■ T {"O^u > A// i.)A >/A/Wa-?C. 0 2JJ_J/o£j2LJmL: S INameContractor -L Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE: ( ) New Building ( ) Alteration ( ) One Family Dwelling ( ) Multiple Dwelling ( )Other Specify:. Units ( ) Other Size ESTIMATED COST OF IMPROVEMENT $(omit cents) PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry ( ) Wood Frame ( I Structural Steel ( .) Other — Specify ( ) Public ( >Llndividual Septic Tank, etc. WATER SUPPLY: ( ) Public ( >1.^lndividual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes I ) Central Basement: ( ) Yes (>t No Stories above basement: ....... Sq. feet (outside dimension) ....: Bedrooms . ; /Baths.....dn /■ HEATING: ( ) Electric (X.Gas ( ) None Type of Roof:( -1 No ( ) Oil ( -^1 No ( ) Coal Other:I ) Unit CHARACTERISTICS: y'-- 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.....Z.;./, 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, Drainfleld, etc.). feet..-.-v 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 Permit: 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. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the Dated Shoreland Management Official Permit Fee $.State Surcharge $. Comments: •c&6- Form No. MKL-0771-002 @ VlCTt 158899 4 CO.. PRdlTlta. FCRtUt rM.LI. MINN INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 1 MINIMUM Shall Be Sq. Ft. aztdLot Area (Square feet)Sq. Ft.Sq. Ft. hJOKffLWater Frontage Ft.Ft. T 7S*IQOBuilding Set Back from High Water Mark Ft.Ft. Building Set Back from State Highway Ft.50 Ft. HOBuilding Set Back from Street or Road Ft.40 Ft. 9^0 & 0.0 Ft.a?_________Ft.Side Yard HOHARear Yard Ft.Ft. lAOccupied Building to Septic Tank Ft.10 Ft. Occupied Building to Absorption System Ft.20 Ft. Elevation at Building Line above High Water Mark_____________/ 2' IS Ft.3 Ft. Inspector's Comments: 6K Inspector's Signature Title Inspection Dated 19 ^ Agency vicT*a uwMM 4 M.. MWTCM. fCMui rau.!. mail. t/. Departnmit of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 MALCOLM K. LEE. Administrator November 29, 1979 Mr. Gary Halseth R. 1 Box 71 Deer Lake Resort Battle Lake, MN 56515 Proposed trailer house on resort. Deer Lake, No. 56-298Re: Dear Mr. Halseth: In order for us to issue a building permit to place a mobile home on your property, we need to know that your sewage system meets the Shoreland Management Ordinance requirements, system must also be large enough to accommodate the mobile home, should you want to hook into one of your present systems. Your Enclosed you will find the proper form and also a list of the licensed sewage system installers. Please have one of these installers check your system to determine If if meets all of the shoreland requirements, and return the form to our office for our records. - .*• Sincerely, (V\ M.A. Blahosky Land & Resource Management enc. mab SHORELAND MANAGEMENT ORDINANCE - DIVISION OF EMERGENCY SERVICE - SUBDIVISION CONTROL ORDINANCE SOLID WASTE ORDINANCE SEWAGE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY PLANNING ADVISORY COMMISSION FUEL AND ENERGY COORDINATIONRIGHT-OF-WAY SETBACK ORDINANCE r ■ ; ■ I . . ■ ' -i ;. / I 1 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 V>' te - Office > low — Inspector Pli.. Card Owner Owner /LaiO! fit Permit No.,LEGAL Date DESCRIPTION AND 1^^ _4d.KHLOCATION Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information. Last Name First Initial IVIailling Address —No. Street, City and State Zip No.Tel. 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 Signature NUMBER OF BEDROOMS;ESTIMATED COST: Ur</UDUKj ^fTIC TAI^SEWAGE DISPOSAL SYSTEM DATA: zSEEPAGE PIT DRAIN FIELD XFt.3(D O GIs.Capacity Sq/Ft. Ft.Ft.Ft.Distance from nearest well 7^Distance from lake or stream Ft.Ft.Ft. zloDistance from occupied building Ft.Ft.Ft. roDistance from property line Ft.Ft. JFt.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time PERCOLATION TEST DATA:Date of First Test , 19 , Rate Date of Second 19 ,, Rate..... 1st Test Taken By First Test -I- 2nd Test 2 Rate2nd Test Taken By The undersigned hereby makes application for permit to install or extend Sewage Disposal System herein specified, agreeing to do ail 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 ise attached mailer notice.) (/ Dated 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 oommenced within six (6) months. Permit: Shoreland i^anagement Office Issued Date;4 42^Fee $Surcharge $ V7 tCComments:.r Form No. MKL-0771-003 vicToa LUHSCfH t CO . eaiHTces. rtoeus rttL* winn 158906 SHORELAND MAIMAGEMEIMT - 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 V low — Inspector Pl».. — Owner Card — Owner Office Permit No,,/LEGAL /'O Date DESCRIPTION AND /LOCATION Lake No.Lake Name Lake Classif.Sec.TWP TWP NameRange IDENTIFICATION: Please Print All Information. Last Name First Initial Mailling Address —No. Street, City and State Zip No.Tel. No. OWNER SEWAGE SYSTEM INSTALLER Name. This System will be ready for inspection on., 19. This space for office use only ,19 ,M Date Rac'd Time Rec'd Phone Call Rec'd By Owner or Agent Signature NUMBER OF BEDROOMS:ESTIMATED COST: SEWAGE DISPOSAL SYSTEM DATA: SEPTIC TANK SEEPAGE PIT DRAIN FIELD GIs.Sq. Ft.Capacity Sq. Ft. Ft.Ft.Ft.Distance from nearest well Ft.Distance from lake or stream Ft.Ft. Ft.Distance from occupied buildinq Ft.Ft. Distance from property line Ft.Ft.Ft. Ft.Distance from bottom to Water Table Ft.Ft. AH distances are shortest distance between nearest points RECORD OF TESTS: Inspection was made on 19 , Time ,JVI By PERCOLATION TEST DATA:Date of First Test , 19 r Rate Date of Second Test.....19 , Rate 1st Test Taken By First Test + 2nd Test 2 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.) Dated Signature Permit: 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. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express Issued Date: Shoreland Management Office Fee $Surcharge $ /nf ■/ Comments:. 1Form No. MKL-0771-003 v'CTea LUNBCCN t ce.. fersus raLi.f. 158906 INSPECTION RESULTS e *■« '••A, Inspector must make all measurements SEWAGE DISPOSAL SYSTEM STATISTICS SEEPAGE PITSEPTIC TANK DRAIN FIELDCATEGORY Should beActual Should be Actual Should beActual Capacity GIs.GIs.S FSF SFS F Distance from Nearest Well 75 50F F F F F F Distance from Lake or Stream F F F F F F 20Distance from Occupied Building 10 20 FF F F FF Distance from Property Line 10 10 10FFF FF F Distance from Bottom to Water Table 4 4FFFF F F Inspector's Comments: 4 J Date of Inspection 19____ Time of Inspection.M Signature of InspectorINTERPRETATION OF ABBREVIATIONS GIs * Gallons SF * Square Feet “ Linear Feet Job TitleF Agency M KL-0771-003-Backer L f 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 — l^j^ector J ' J-a Xe Permit No.LEGAL 2.Date.DESCRtPTION AND LOCATION VOn,/i TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information Initial Mailing^ddress— No. StreeLv City and StateLast Name First Zip No.Tel. No. r?^sF(°. / o ^ Owner » NameContractor Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE: ^..'T'^ne Family Dwelling ( ) Multiple Dwelling NON-RESIDENTIAL PROPOSED USE: roj>iA ( ) New Building (^+^lteration Specify:, r-v-7 tv.J20 X30 Units ( ) Other ( ) Other Size ESTIMATED COST OF IMPROVEMENT $(omit cents) PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry (uHlCood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public (i-+^dividual Septic Tank, etc. WATER SUPPLY: ( ) Public ( ^'^dividual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central Basement: ( ) Yes ( Stories above basement: ........ Sq. feet (outside dimension)..... Bedrooms la.Q.O.... /Baths HEATING: ( ) Electric ( ) Coal Other: ( ) None Type of Roof:( ) Oil ( ( ) Unit p-^crl^,/ /viuer- c*.- ...... feet. 600CHARACTERISTICS: .......Lot Area is square feet.Water frontage is feet. (Building Line) feet JOOl.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 ^Q.±.feet.feet — from road or street is uo.±.s£MD.±.feet. Rear yard is feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.). and feet. a:)±. 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. Shoreland Mt^agement Official Dated 2/Permit Fee $.State Surcftarge $. Comments: I Acn — xme. ___Jc C.CiJUX2i\^ cLCj2i A/Vv Form No. MKL-0771-002 158899 VICTAII UlMBCCa 4 M.. POIMTIM. VE44U4 r«.L«. 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 Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address— No. Street. City and State Zip No.Tel. No. 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 ( ) Other Size ESTIMATED COST OF IMPROVEMENT $(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 ( ) Individual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms Baths HEATING: ( ) Electric ( ) Gas ( ) Coal Other: Type of Roof:( ) No 1 ) 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 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 ail 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 Surcliarge $. Comments: nqt tlFD 50^7T Form No. MKL-0771-002 158899® V,CT« kUNBtfl I. FCI INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS i MINIMUMShall Be 4 Sq. Ft, Sq. Ft.Sq, Ft.Lot Area (Square feet) Ft.Ft.Water Frontage Ft.Ft.Building Set Back from High Water Mark 50 Ft.Building Set Back from State Highway Ft. 40 Ft.Ft.Building Set Back from Street or Road &Ft.& Ft.Side Yard Ft.Rear Yard Ft. 10 Ft.Occupied Building to Septic Tank Ft. 20 Ft.Occupied Building to Absorption System Ft. Elevation at Building Line above High Water Mark_____________3 Ft.Ft. Inspector's Comments: Inspector's Signature Title Inspection Dated 19 Agency vicTo* LUHttfCH t M . Mianai. rcaava r*ua. wca. GRID PLOT PLAN SKETCHING FORMfeet/inches.Scale.r Each grid equals .19.Application for Building Permit Dated. 19Application for Sewage System Permit Dated Sewage System Permit Number.Building Permit Number. Applicant agrees that this plot plan is a part of application (s) indicated above. 19Dated. ® drawing of your lot. Indicate all present buildings w.1.th solid lines and ell proposed buildings or additions with dotted linps. Also indicate in feet; lake setback, side yard setback end rear yard setback-* S ignatu re : ..I I - ,' 1 : 'TOW:1 p I*—.-I t ■1 1 ' i- .I T.l ii cI ;-I t-r-|1 Ui !i MKL-0871-029