HomeMy WebLinkAboutHead Lake Camp Assoc Inc_53000200115001_Shoreland Permits_ (2)r
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
WHITE - Office
GOLDENROD - Inspector
YELLOW - Owner (after issue)
OTTCR TflilCOVATY-ailAlfOTM
Permit No.E COMPLETED IN ORDER TO BE PROCESSED.APPLICATION MU:
LAKE / RIVER NO. / LAKE/rA/ER NAME LAKE/RIVER
CLASS
SECTION TWPNO.RANGE TWP NAME
/3S'3? A-e’X/
PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS / J L, ///e.<=^c/
LEGAL DESCRIPTION DEVELOPED
/^T /}I J -r Y>Tg2-3 ^/■TSY6'UNDEVELOPED
f7»Last Name First Initial Mailing Address Daytime Phone No.
Ca/TJ/> yfsjrtcTf,A ^trip'sProperty
Owner jr^.7 3
ctJtI',' /A? S'yCS
A'7'_________Contractor
Name
Lie.#
PROPOSED PROJECT (please circle the appropriate number)ONSITE WATER SUPPLY
b^lndividual ( ) Public ( ) None
NOTE; MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM
( ) L&R Cert, of Compliance within 5 yrs.
r/) Comoliance Insoection Reoort within 3wrs.
((1 ) New Dwelling t (p003 (5 ) RCUAear_____
Add'n To Non-Owelling (8 ) Storage Structure
(10) Non-Conf. Replacement (identily)"_______
(11) Other (identify)______________________
(12 ) Deck______________________________
(13) Fence_____________________________
(2 ) Add'n to Dwelling/Attached Garage ( 3) Replacement Dwelling*
( 6 ) Detached Garage
(9) W.O.A.S.(Attached) 3l3illhu
{ ) OTWMD 'Must have Sewage System 4ppr(f4il~
from OTWMD prior to issuing Site Permit.
Contact Rollie Mann at 218-864-5533
( ) Undeveloped Lot
'Removal of Existing Dwelling Verified by L&R "Existing Non-Conf. Structure Verified by L&R
Inspectors tnilial/Date inspectors Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attach^Garage^''/^ X
Ft X JZ
CHARACTERISTICS OF PROPOSED NON-DWEU.ING
Outside
Dimenaon Outside
DihiensionFt. X Ft."Outside Dimension
Sq Ft.
Setback to Lotline T’ e>-f- Ft. & Ft.**
Setback to Right of Way -y~ Ft."
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level 3 -h
Setback to Septic Tank /fe Ft.
Setback to Drainfield 7^ Ft.
Setback to Bluff
Total Bedrooms ^
Maximum Proposed Height IT.
Ft."Ft. X Ft."
Sq. Ft. \
Setback to Lotlin^
Setback to Right of W^
Setback to Ordinary High Wbter Level
Elevation Above Ordinary High Wa(pf
Setback to Septic Tank__
Setback to Drainfield__y
Setback to Bluff /
Maximum Propo^ Height
Roof Changer ) Yes ( ) No
Bathroom Proposed ( ) Yes ( ) No
Sq.Ft.
Setback to Lotline ___
Setback to RighLpf Way
Setback to Ordinary High Water LeVel __
Elevation Above Ordinary rljglfWater Level
Setback to Septic Tank
Setback to Drainfield _
Setback to Bl ________
Maximum^oposed Height
( ) Bodlhouse
( ) jjazebo
**ProJect/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft.&Ft.”Ft.&Ft.**
Ft./
Ft.
Ft.Ft.Ft.
Level Ft.
Lt.Ft.Ft.Ft.
Ft.Ft.Ft.Ft.
Ft.Roof Change ( ) Yes ) No
Basement ( )Yes (^
Walkout Basement ( ) Yes (side profile required) (^) No
No ( ) Screen Porch
( ) Storage Structure
Topographical Alteration / Earthmoving
^ None
* Must include on scale drawing,
additional Permit may be required.□ 20 Cubic Yards or Less *□ 21 Cubic Yards - 999 Cubic Yards*□ 1,000 Cubic Yards or More*
L^ss TLo^o
Bluff ( )Yes ^NoCHARACTERISTICS OF LOT:Lot Area.Sq. Ft.Water Frontage Ft.
.%.%
Building Surface Ratio Impervious Surface Ratio
TH/S IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of said Ordinances.I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed.
Date: /^y^
^ ^ Signatd^ of Property Owner^^ent for Owner
ZsjKfi__________ Any
/ Land & Resource Management Official
Date:
- rjQ1^40 RECEIPT NO. lolfc^'SlPROJECT(S) TOTAL SQ.FT.PERMIT FEE $
(9 Mi Uj, MH'!5 S?Rs 6 Y-f Date StampComments:
Gik ^5~ -
QAn ^ (polo
L&R Initiali#esiForm No. BK — 04-2014 354,252 • Victor Lundeon Co., Printers * Fergus Falls, Minnesota
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537218-998-8095 .J 'T//////
www.co.otter-tail.mn.us ’ 'j''
WHITE - Office
GOLDENROD - Inspector
YELLOW - Owner (after issue)■“'Jt i
OTTER TflllCOVlITT-aiillllOTI b^'i IPermit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED.
i
TWP NAMELAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP NO.RANGE
■ vr’ ■'■*\//'
PARCEL NUMBER (S)s
\LEGAL DESCRIPTION \DEVELOPED
/./ ^UNDEVELOPED
j
Daytime Phone No.First Initial Mailing AddressLast Name
■7A bjry- A^ AssProperty
Owner >' / ^A /'//y
7/, /rr^ / ^ ^ 7 rXContractor
Name
Lie.#1i
■1
;PROPOSED PROJECT (please circle the appropriate number)ONSITE WATER SUPPLY
( ) individuai ( ) 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.
(7 ) 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
(2 ) Add'n to Dwelling/Attached Garage ( 3) Replacement Dwelling*
(5) RCU/Year.
tl) New Dwelling
—-(7 ) Add’n To Non-Dwelling (8 ) Storage Structure
( 6) Detached Garage
(9) W.O.A.S.
(10) Non-Conf. Replacement (identify)"
(11) Other (identify)_______________
(12) Deck______________________
(13) Fence_____________________
i ■
„!
( ) Undeveloped Lot
i‘Removal of Existing Dwelling Verified by L&R "Existing Non-Conf. Structure Verified by L&R■
Inspector's Initial/Date Inspector's Initial/Date
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage) . .. /■
Outside Dimension
Sq. Ft.
Setback to Lotline
Setback to Right of Way 'T-* y~* Ft."
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 ()K ) No
Basement ( )Yes ('x, )No
Walkout Basement ( ) Yes (side profile required) ( ■ ) No
CHARACTERISTICS OF PROPOSED NON-DWELLING
Outside
Dimension
-4
A 'b Ft. X Ft."
■ ' '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 ( ) 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
- -'■ r /■Ft.**Ft.&Ft.&Ft.";Ft."Ft. & /-Ft.*'/Ft.
3 Ft.
Pf.**1Ft.Ft.•i
Ft.Ft.
Ft.Ft.
Ft.Ft.1\Ft./I Ft.Ft.
;Ft.V ■f
1( ) Screen Porch
( ) Storage Structure ■I
Topographical Alteration / Earthmoving
.£3 None □ 20 Cubic Yards or Less * □ 21 Cubic Yards - 999 Cubic Yards*
* Must include on scale drawing,
additional Permit may be required.
•(
□ 1,000 Cubic Yards or More*
1/ ''r f-f-r Bluff ( ) Yes ^) NoCHARACTERISTICS OF LOT:Lot Area.Sq. Ft.Water Frontage Ft.
i /.% .%■1
Building Surface Ratio Impervious Surface Ratio i{
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 buiiding footings have been constructed.
1
Date:
Signature of Property Owner/Agent for Owner
•13S/1C iDate:7
3L " ‘•J/ ^
Land & Resource Management Official IISYOPROJECT(S) TOTAL SQ. FT.,PERMIT FEE $RECEIPT NO.i
3ti ,1i-C- VComments:yI
i i\I^SCANNEDT)Yby iitiH-i LJ Li‘I J^ ' 7i~nb Afv'
1Form No. BK — 04-2014 IsOY ini 354,252 • Victor Lundesn Co., Printers • Fergus Falls, Minnesota
r ,
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
-2N X €i
Structure Set Back from Ordinary High Water Level Ft.Ft.
Structure Set Back from Top of Bluff Ft.Ft.
55^Structure Set Back from Road Right of Way Ft.Ft.
g-*'1^^ Ft.Structure Set Back from Lot Lines Ft.&Ft.
Structure Height Ft.Ft.
hStructure Set Back from Septic Tank Ft.Ft.
Structure Set Back from Drainfield Ft.Ft.
Elevation Of Lowest Floor Above Ordinary
High Water Level Ft.Ft.
Land Slope at Building Site %%
Inspector’s Comments / Sketch:
Inspector’s Signature
Date of Inspection
\'-K
Time of Inspection
>u-ii 'AKProject Approved
Date / Initial
/
r: •
-■'j ■ -f... .% •
WHITE - Office APPLICATION FOR SITE PERMIT
GOLDENROD - Inspector
YELLOW - Owner (affer issue)
PINK - Assessor
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us ^3mPermit No.PLEASE PRINT OR TYPE ALL INFORMATION
^yrfiPNO. ^^,rSnge ^L/:TWP NAMESECTIONLAKE/RIVEF^
CLASS l/LAKE / RIVER NO.E/RIVER NAME
c.c«(L l<—a/3
PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)
l-\ e , )2_ ( cjn LJ i 11-^3 3 G O O ) O ^ 3. S’ O O /
LEGAL DESCRIPTION
f C- "(-€) 'f~c^ IPcK ri~ of Cj L- f
Daytime Phone No.Initial Mailing AddressFirstLast Name
Property
Owner C/\?0 ftoy _______________
f^Cy\r\ L? 1 11<> K4 h\j 5 fer- 7
r-^-l ~7!>0 0i irV\1/^
Contractor
Name
Lie.# V 7Ml
PROPOSED PROJECT (please circle the appropriate number)
(2) Add’n to Dweiiing
(5) RCU/Year_____
(7) Add’n To Non-Dwelling (8) Storage Structure
(10) Non-Conf. Repiacement (identify)___________
(11) Other (identify)________________________
•Existing Dweiiing to be removed prior to__________
ONSITE SEWAGE
TREATMENT SYSTEM
\^) Permit NoiJ H ‘JlO ~ ^ ~ //.S V3
( ) OTWMD 'Must have Sewage System Approval
Irom OTWMD prior to issuing Site Permit.
Contact Rollie Mann at 218-864-5533
ONSITE WATER SUPPLY
Individuai ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
/<{T)^eplacement Dwelling
XBTAttached / Detached Garage
(9)W.0.A.S.
(1 ) New Dwelling(t7^HA'R_/_3JL5
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
DImensio
CHARACTERISTICS OF PROPOSED NON-DWELUNG
Outsk(e Dimei^n
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage)
/H Ft.X Ft.Ft."Ft. XOutside Dimension___
Sq. Ft.
Setback to Lotline __
Ft. X Ft."\
Sq. Ft. \
Setback to Lotiihe ______
Setback to Right of ww _
2^^ Hj,,,-FSetback to Ordinary Higmt(
Elevation Above Ordinary
Setback to Septic Tanlt
Setback to Drainifeld____
Setback to BIWf________
Maximum Proposed Height
)Yes ( )No
Ft. & 50~^ Ft.*^
Setback to Right of Way i O0 ~f—
IX Ft.
Sq. Ft.
Setback to LotliJte___
Setback to Right of Way
Setback to Ordinary HiglWat^evel __
Elevation Above Ordinary HiolvWater Level
Setback to Septic Tank/
Setback to Drainfi^____
Setback to BluJfC_______
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
**Project/Lottines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft.&Ft."
■t."Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level _
Setback to Septic Tank FLL/"
Setback to Drainfield 7- Ft.
Setback to Bluff N O
Ft.
Ft.
Ft.
Ft>
Total Bedrooms
Maximum Proposed Height
Roof Change ( ) Yes (p< ) No
Basement ( ) Yes ( ;c) No
ao ^Ft.
Ft.
^^_Roof Change (
Bathroom Proposed ( ) Yes ( ) No
( ) Screen Porch
( ) Storage StructureWalkout Basement ( ) Yes (side profile required) (^ ) No
* Must Include on scale drawing,
additional Permit may be required.
Topographical Alteration / Earthmovina
/St None
CHARACTERISTICS OF LOT:
□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More*□ 20 Cubic Yards or Less *
Water Frontage i Q Q O T~
_____________ T go
CK l^ Sq. Ft..Ft.Bluff ( )Yes (^)NoLot Area,
Impervious Surface Ratio:X100 =.%Total Impervious Surface Onsite (FTg Total Lot Area (FT')Impenrious Surface Ratio
THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed.
■S'Date:
Signature Tty Owner / Agent tor^/3lld7Date:
/¥/j5a&Land & Readurce management Office . .1 .‘VP^I>A-4-I5‘c>03MPERMIT FEE $PROJECT(S)TOTAL SQ.FT.,RECEIPT NO.
Comments: Kiz p
Ta t I t 4 £.1. L‘Uh I j-in
It . V-XP iovi lyik f r-.’t't') p >vJ ■ r i
329.582 • Victor Lundeen Co., Falls, Minnesota
-f- .-if Otili V"Y>0
i*TT>0"3
Form No. BK — 1003-0407
IN #OR SITE PERMITWHITE - Office
GOLDENRQD - Inspector
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
YELLOW - Owner (after issue)
PINK -Assessor
Permit No.PLEASE PRINT OR TYPE ALL INFORMATION
TWPNAMESECTIONTWP NO.yKANGE ^LAKE/RIVE(^
CLASSLAKE/RIVER NAMELAKE / RIVER NO./1/(yv/3^y35'sy- p- / 3 NS
PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)
lA a ^ cJi'1 I ^5 3 000 a-1 019^^00 I T U I
IXLEGAL DESCRIPTION
Ra. rf or Cj L. ^ L/I 6?.9 Io
Daytime Phone No.Mailing AddressFirstInitialLast Name
Cii.-np jProperty
Owner Po feo-rc _______________<^ -~7 3oOrtf
Contractor
Name .
Lie.# V'
l.- IX JXX j 'jR'M
PROPOSED PROJECT (please circle the appropriate number) ^^
) New Dwelling
(_l^4 VMHA'R i i ■.
ONSITE SEWAGE
TREATMENT SYSTEM
) Permit No. ~ 9S‘^>S ' //S 73
( ) OTWMD 'Must have Sewage System Approval
from OTWMD prior to issuirtg Site Permit
Contact Rollie Mann at 218-864-5533
ONSITE WATER SUPPLY
\Oj Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
'Peplacement Dwelling
Attached / Detached Garage
( 2 ) Add'n to Dwelling
(5 ) RCU/Year______
(7) Add’n To Non-Dwelling ( 8 ) Storage Structure
(10) Non-Conf. Replacement (identify)___________
(11) Other (identify)________________________
'Existing Dwelling to be removed prior to__________
(9)W.0.A.S.
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
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 i Oi ■ " Ft.**;^
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level
Setback to Septic Tank ^ *0 ^ Ft^'
Setback to Drainfield 50 pt.
Setback to Bluff ^ O
Total Bedrooms
Maximum Proposed Height
Roof Change! )Yes (X ) No
Basement ( )Yes { y) No
Walkout Basement ( ) Yes (side profile required) {x ) No
O O Ft. X Ft.”Ft. X Ft. X Ft."
Sq. Ft.
Setback to LotiTne___
Setback to Right of Way
Setback to Ordinary High Water Level __
Elevation Above Ordinary,High,)/Vater Level
Setback to Septic T^_______X Ft.
Setback to Drainfield____
Setback to Bfuff________
Maximufh Proposed Height
Roof Change ( )Yes ( )No
Bathroom Proposed ( ) Yes ( ) No
Ft. & 5o-t" Ft.*^Sq. Ft.
Setback to Lotlihe.^___
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^foposed Height
( ) Boathouse
( ) Gazebo
’'*Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / inspection
/Ft.&Ft.”
Ft.& /Ft.”
^ Ft.”IX /Ft.”Ft.
iH_Ft;'Ft.Ft.
Ft.
Ft.Ftf"^Ft.Ft.\
Ft.3.0 <Ft.
Ft.Ft.
( ) Screen Porch
( ) Storage Structure
' Must include on scale drawing,
additional Permit may be required.
Topographical Alteration / Earthmovinq
None □ 20 Cubic Yards or Less * □ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More*
CHARACTERISTICS OF LOT:
iM L-^
Water Frontage ) Q O Q
________________________ T
iXBluff ( )Yes p<)No4a I Sq. Ft..Ft.Lot Area.
Impervious Surface Ratio:X100 .%
Total Impervious Surface Onsite (FT»)Total Lot Area (FT^)Impervious Surlace Ratio
THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth
and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become
a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express con
dition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota.
This permit may be revoked at any time upon violation of said Ordinances.
I understand that it is my responsibiiity to inform the Land & Resource Management office once the building footings have been constructed.
Date:
Signature of Property Owner / Agent for Owner
Date;
Land & Resource Management Office
PROJECT(S) TOTAL SQ. FT. f V V/PERMIT FEE $RECEIPT NO.
'■ O S h Cj i.-'.Q ! A
I • X. / .•"
lA C e vi-iC V~I ~t~' o F pIA t'V tt W- W bComments:
tarv (
3l f H a r Ui--\ ^< 'K f <r- '
329,582 • Victor Lundeen Co., Printers • Fergus Fails, MlnnesSc^^^Form No. BK — 1003-0407
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
l^<^-
itStructure 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.
IOD' ^ Ft. & /<30' ^Ft.&Ft.Structure Set Back from Lot Lines Ft.
19,'Ft. Ft.Structure Height
Ft.Ft.Structure Set Back from Septic Tank 57
6(d Ft.Ft.Structure Set Back from Drainfield
Elevation Of Lowest Floor Above Ordinary
High Water Level Ft.Ft.
Land Slope at Building Site %%
dInspector’s Comments / Sketch:
J
iS
1- H -
1
69’
I
Inspector's Signatur^r^
7-^ -67 7
of Inspection
Time oNnspi
'\<d^royecf Approved
Date/Initial \
W£y
4-
k': *
**
0
•- •
f
..'•—••’■I-:-..
».\
“ 1
■ ,- ■■-'V
KT
*fi4-I V
:ii?!■'•■
f.■\;
tip ^ -:.
WHITE - Office
GOLDENROD - Inspector
YELLOW Owner (after issue)
PINK - Assessor
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWP NO.RANGE TWP NAME )
J3S' 37
PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)
LEGAL DESCRIPTION 7 727^/a-1
FirstLast Name Initial Mailing Address Daytime Phone No.
Ax 4^____________iProperty
Owner ~
Contractor
Name
Lie. #/A'
PROPOSED PROJECT (please circle the appropriate number)
' Mj New PwRllinn ' (2) Add’n to Dweiling,/TTTmHA'R /7(.5) RCU/Year
(7 ) Add'n To Non-Dweliing (8) Storage Structure
ONSITE WATER SUPPLY
epiacement Dweiling ^^Individual ( ) Pubiic ( ) None
(6 ) Detache^arage J NOTt MN Rules Chpt. 4725 (MN Well (9) W 0 A CtfajpJjllBlfeM^ (minimum) structure
' ' ^ t tXi setback to a well. . .
CHARACTERISTICS OF PROPliSED NON-DWELLING
Outside
Dimension
ONSITE SEWAGE
TREATMENT SYSTEM
;>< Permit
( ) OTLSD * This permit is only valid after verification
horn the O.T.L.S.D. that a confirming sew
age system will be installed to service diis
lot contact Rottie Mann at 864-5533.(10) Other..•Existing Dwelling to.be removed before.
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)OiS^
Dimeheion
CHARACTERISTICS OF PROPOSED DWELLING
Ft. X . 5^ Ft.**Outside
- Dimension Ft. X Ft.**
Ft. X Ft.**
Setback to Lotline iS ^ ■ Ft.& ‘JO’ Ft.**
Setback to Right of Way ^ Ft.**
Setback to Ordinary High Water Level "9“ Ft.
Elevation Above Ordinary High Water Level ^ Ft.
Setback to Septic Tank
Setback to Drainfield Ft.
. Setback to Bluff Ft.
■ Total Bedrooms
Sq. FtX
Setback fosLotline ___
Setback to Ri^t of Way
Setback to Ordinaw High Water Level
Elevation Above Ordin^High Watep«vel
Setback to Septic Tank
Setback to Drainfield ^
Setback to Bluff
Maximum Proposptf Height_____
Roof Changpq ) Yes ( ) No
Bathroorrfproposed ( ) Yes ( ) No
Sq. Ft. \
Setback to LoHjne___
Setback to RightoLWay
Setback to Ordinary PHoh Water Lev^__
Elevation Above Ordinary'ljigh yifffler Level
Setback to Septic Tank
Setback to Drainfield A
Setback to Bluff
Ft.&• *Ft.&Ft.**.
Ft.**Ft.*>
Ft.Ft.
Ft.Ft.Ft.
Ft.Ft.
Ft.3-
/ Ft.Ft.Maximum Proposed Height 7A Ft.
Roof Change ( ) Yes (^^ No
Basement ( ) Yes (^ No
Walkout Basement (' ) Yes (^^
Ft.Maximum Prafosed Height
( ) Bo^use
( l/^zebo
Ff>
( ) Screen Porch
( ) Storage StructureNo
**Proiect/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection
Topographical Alteration / Earthmovinq
None □ 20 Cubic Yards or Less * □ 21 Cubic Yards - 299 Cubic Yards*
* Must include on scale drawing
Permit may be required□ 300 Cubic Yards or More*
CHARACTERISTICS OF LOT:
Sq. Ft.A Ft Bluff ( )Yes (^NoLot Area.Water Frontage
-Impervious Surface Ratio:xioo =,%
Total Impervious Surface Onsite (FT^)Total Lot Area (FT^)Impenrious Surface Ratio
THIS ISA 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 buiiding footings have been constructed.
Date:
Signature of Property Own^pA
Land & Resourc^Management Office
/
CDate:
PERMIT FEE $ /'7S~/^PROJECT(S)TOTALSQ.FT..RECEIPT N
CO__
£ A? /AComments:
/3^A A. /**,
7 _f
Form No. BK — 1003-0S0S 322,179 • Victor Lundeen Co., Printers • Fergus Faiis, Minnesota
alt
■
WHhTE - Offic-3 APPLICATION FOR SITE PERMIT
GO* OENR(ip - Inspector ,
YELLOW - Owner (after issue)
PINK - Assessor
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
•GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us /• ''i/PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKBRIVER
CLASS
SECTION TWPNO.RANGE TWP NAMELAKE/RIVER NAMELAKE / RIVER NO.
3f \
PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)
1
LEGAL DESCRIPTION
..0.1 >/3.'f \Oe,I
i:r
Daytime Phone No.First Initial Mailing AddressLast Name
■«Property
Owner ^AO /fJ
Contractor
Name
Lie.#
ONSITE WATER SUPPLY
Individual ( ) Public ( ) None
ONSITE SEWAGE
TREATMENT SYSTEM
PROPOSED PROJECT (please circle the appropriate number)
(2) Add’n to Dwelling >f3)
(5) RCU/Year_______ ) Detached Garage, ,,, I N&TE: MN Rules Chpt. 4725 (MN Well
'■ (T'Code) requires a 3’(minimum) structure (8)StorageStructure (9)W.0.A.S. ^ ^ , V] setback to a well.
_ *Existing Dwelling to be removed before_
(1) New Dwelling
1mh/yrZ;Z^^
) Add’n To Non-f)w«ltlRg
(10 ) Other____
placement Dwelling
(^Permit No. ■ - /
( ) OTLSD * This permit is only valid afler verifeation
from the 0.T.LS.D. that a conforming sew
age system will be installed to service this
lot contact Roltie Mann at 864-5533.
(
CHARACTERISTICS OF PROPOSED W.O.A.S.
(WATER ORIENTED ACCESSORY STRUCTURE)
Outside
Dimension
CHARACTERISTICS OF PROPOSED DWELUNG
Outside
Dimension
CHARACTERISTICS OF PROPOSED NON-DWELUNG
Outside
DimensionFt."Ft. X_^Ft.x_^
Sq.Ft.
Setback to Lotline
Setback to Right of Way
Ft. X Ft."
Sq.Ft._______
Setback to Lotline ___
Setback to Right of Way
Setback to Ordinary High Water Level
Elevation Abqve Ordinary High Water
Setback to Septic Tank X y\
Setback to Drainfield
Setback to Bluff__
Maximum Proposed Keight______
Roof Change ) Yes ( ) No
Bathroom Proposed ( )Yes ( )No
So. Ft.
Setback to Lotliqe ___
Setback to Right of yifay
Setback to Ordinary Hig(i Water LevelX
Elevation Above Ordinary High Water Level
X Ft.
^^FtS_SJ,SLFl-
Setback to Ordinary High Water Level
Elevation Above Ordinary High Water Level
Ft.&Ft."Ft."
Ft."
Ft.
Setback to Septic Tank * Ft.
Setback to Drainfield / Ft.
Ft.
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 Applica'tfon / inspection
Setback to Bluff
Total Bedrooms
Maximum Proposed
Roof Change ( ) Yes (
Basement ( )Yes ( .^
Walkout Basement ( ) V^s' (
Ft.
Ft.HSi^t Ft.
No
=t.Ft.
( ) Screen Porch
( ) Storage Structure
lo
**
* Must include on scale drawing
Permit may be required
Topographical Aiteratlon / Earthmovino
□ .None □ 20 Cubic Yards or Less * □ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More*
CHARACTERISTICS OF LOT:
Ft.
-'^^ota^ jS^^FT^)
Bluff ( )Yes ( VNoWater FrontageLot Area.
/■essTImpervious Surface Ratio:X100 =%
Impenrious Surface RatioTotal Impervious Surface Onsite (FT*)
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 :iDate:
Signature of Property Ownern ,^jyix5o
RECEIPT NO.
h- 'O. /■ •Date:
Land & Resource Management Office
PERMIT FEE $ / V ~ ^PR0JECT(S) TOTAL SQ. FT.,
?r-J / ^7 y^a a / J'? // ^
y - ^ - r . . . - . ^Br.A
Comments:
Form No. BK — 1003-0505 322,179 • Victor Lundeon Co., Printers • Fergus Faiis, Minneso
*
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
Structure Set Back from Ordinary High Water Levei Ft.Ft.ie>D
Structure Set Back from Top of Bluff Ft.
Structure Set Back from Road Right of Way Ft. Ft.
S'/?5^Ft. &Structure Set Back from Lot Lines Ft.Ft.Ft.&
i13Structure Height Ft.Ft.
rStructure Set Back from Septic Tank Ft.10 Ft.lo
Structure Set Back from Drainfieid Ft.Ft.<9^Elevation Of Lowest Fioor Above Ordinary
High Water Level 33Ft.Ft.
Fl/tTLand Slope at Building Site %%
-MtQuW*
Inspectors Comments / Sketch:
I
S.
iTiTActito 0/iAuj,H<r
fh(L
-V'• V-f•V
Inspector's Signature
^hr>/oS-
• Date of Inspection
Time of Inspection
%u))U^^)iect Appiwed
Date / Initial
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Head Lake Camp Association, Inc.
42300 Head Lake Road
P. O. Box 98
Richyille, MN 56576
Phone 218-346-7200
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7
305 55^0“? 33 M4y ) 2 ,951^
HEAD LAKE RESORT
BARRY HILLARY
RR 1 BOX 132
RICHVILLE MN 56576
II
j 758-2719 (Sunrise Resort)
! SEASONAL
I DEAD LAKE
! NON-COMMUNITY WATER
RESORT -1 unit
R6A/MHR- -24 -sitotr
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Grade & Fill Permit #n!3613 k
PROPERTY OWNER H«-^c> Lk OLtw.
LAKE NO. g<-^0 SEC. T^\ TWP. NAME
1 ^ ______
asso 0^
fioo S^'-IOS^ TT>
an. TT>
LEGAL DESCRIPTION:
UJftihouTS(A v\\| W>v■Vy'««4»A*eC w(c)k«WORK AUTHORIZED
Q z.c* t
OV>\
C_0*^ X’Vv fc-wV*-«. ^^ I Y'W C V4** ‘v'X No No ^a lr\9 V\
Cl^ ros.y^\ VjsiVU .ejN w^-Vn mo
•s;xv<i_.*3^ V*Ck.Sj4\?■'
J'^x ^S~V r7/I0 Y oC>—
(^ O'tV ^
NOTE: This card shall be placed in a conspicuous place not more tha
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., ^
TVl
n''4-Tieet above grade on the premises on which
'TTU
1. EARTHMOVING SHALL BE DONE BETWEEN )o- IS^!^ & U-Zr-Q:?
2. Entire area shall be stabilized within 10 days of completion of any earthmoving.
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.
6. Erosion control measures must be —=—
W.
\
GRADE & FILL APPLICATION
OTTER TAIL COUNTY LAND & RESOURCE MANAGEMENT
121 W JUNIUS SUITE 130, FERGUS FALLS, MN 56537 218-998-8095
Otter Tail County’s Webside: www.co.otter-tail.mn.us
PERMIT NO.Application Fee
Receipt Number
PROPERTY OWNER
MAILING ADDRESS
IC. 1) !/i//k:? / /pfa/ ^ <rJ 3CITY, STATE, ZIP
DAYTIME PHONE NUMBER
M.LAKE WO.SZ- CLASS
7 - 00/9 - A/- ________
LAKE NAME
PARCEL NUMBER (S)_
SECTION ^ / TWP RANGE 9 TWP NAME
‘4-LEGAL DESCRIPTION
E-911 PROPERTY ADDRESS
Received
L&R Official DATE
PROJECT REQUEST (provide the scale drawing on back)
FT*CUT AREA:FT. X FT. =
FT*FILL AREA:FT. X FT. =
MAXIMUM DEPTH OF CUT:FT. MAXIMUM DEPTH OF FILL:FT.
YDS’TOTAL CUBIC YARDS OF EARTHMOVING REQUESTED:
DESCRIBE YOUR PROJECT BELOW
!
ofproPertyowner/agent for owner DATE
BK04/03 313,060 • Victor Lundeen Co., Printers • Ferpus Fate, MN • 1-800-340-4670
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