The URL can be used to link to this page

Home My WebLink AboutHead Lake Camp Assoc Inc_53000200115001_Shoreland Permits_---------------------------------- '■-•''.y' —• APPLICATIOiV FOR SBTE PiRMBT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE-Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor 0 2^ -S'?'PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE/RIVER NAMELAKE / RIVER NO.LAKE/RIVER CLASS .J/ SECTION TWP NO.RANGE TWP NAME 33 PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS S3^ j;is - ipfp/ ' LEGAL DESCRIPTION Last Name First Initial Mailing Address Daytime Phone No. O /.0k-r 'K;c(,^rU-e sa>^7(^ SKK-Yzct, ^r.r>^er.Property Owner BKicContractor Name .Lie. It .PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling ONSITE WATER SUPPLY ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM)‘‘^placement Dwelling Individual( 2 ) Add'n to Dwelling ( 5 ) RCUA'ear_____ ( 8 ) Storage Structure _ 'Existing Dwelling to be removed before. Vi Permit (6 ) Detached Garage (9) W.O.A.S. ( ) OTLSD * This permit is only valid after veriricalion from the O.T.L.S.D. that a conforming sewage system will be installed to service this lot contact Rottie Mann at 864-5533. ( 7 ) Add’n To Non-Dwelling ... (.10 ) Other CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension ■ Sq.;Ft. ^O , ■...Setback to Lotline Ft. & Ft." Setback to Right of Way ^ G-4" Ft." Setback to Ordinary High Water Level _ Elevation Above Ordinary High Wafer Level Setback to Septic Tank /O '^ Ft. . Setback to Drainfield Ft. . Setback to Bluff /f/0 ■ . Maximum Proposed Height ^P' -Ft. CHARACTERISTICS OF PROPOSED NON-DWELLING Outside^ Dimension/6 AO_ Ft. X Ft."Ft. X Ft>* Ft. X Ft." Sq. Ft._______\ Setback to Lotline \ Setback to Right of Way Setback to Ordinary High Watfei^evel __ Elevation Above Ordinary Hig^Walsr Level Setback to Septic Tank / Setback to Drainfield / Setback to Bluff / Maximum Proposed Weight ^ Bathroom ProposM ( ) Yes ( ) No 'Sq. Ft. S^lFt.&Ft." ack to Lotline ___ SetbM to Right of Way SetbackXo Ordinary High Water Level/ Elevation ^ve Ordinary High Wafer Level Setback to SeMc Tank Setback to Drained Setback to Bluff/_ MaximurrpPfoposed Heigflt ( ) Boathouse ( ) Gazebo Ft.&Ft." Ft."Ft." Ft.Ft.Ft. Ft.Ft.Ft' Ft. XFt:Ft.Ft. Ft.Ft.Basement_______ Walkout Basement__ i Total Bedrooms J7- Yes -/} No Ft.Ft. ( ) Screen Porch ( ) Stohine Structure **Project/Lotlines/Right-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: Yes No.. Lot Area.Water Frontage .Ft.Bluff /L ^ AjPj6>^<0 Total Lot Area (FP) I ■Impervious Surface Ratio:X100 Total Impervious Surface Onsite (FT^)Impervious Surface Ratio THIS /S A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: ( 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 vvhom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter TaiLCounty, 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 & Re^urce Manage iffice,«fhce the building^otings have been constructed. '•yDate: Signature of P^perty Owner ■< Date:CJC.^ (l>'7cr'0Y Land & Resource Management Office —Tt'rr'PROJECT(S) TOTAL SQ. FT..^ PERMiT FEE$RECEIPT NO. 'BnA t-J cl Avl/Comments: X/'lA.K Form No. BK — 0203-0501 313,012 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota 1 APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-9^8-8095^ 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN www.co.otter-tail.mn.us / WHITE - Office GOLDENRODf- Inspector YELLOW - Owner (after issue) PINK - Assessor d)i7 Permit No.PLEASE PRINT OR TYPE ALL INFORMATION TWP NAMERANGETWP NO.LAKE/RIVER CLASS SECTIONLAKE/RIVER NAMELAKE / RIVER NO. I H-ca f) Lal>^//s: jj PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) ____________Ycr/'jiC' ■N LEGAL DESCRIPTION Daytime Phone No.Initial Mailing AddressFirstLast Name A /a irg SProperty Owner BKic So Ci^Ea^Ki yy)jOContractor Name Lie. It ONSITE SEWAGE TREATMENT SYSTEM Permit No.-^'V i-r~ . , { ) OTLSD * T/iis perm/r is only valid alter verification from the O.T.L.S.D. that a conforming sewage system will be installed to service this tot contact Rollie Mann at 864-5533. ONSITE WATER SUPPLY ( ) Pubiic ( ) None NOTE: MN Ruies Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. 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) Other ^^Tp^lacement Dwelling ^) Individual (6) Detached Garage (9) W.O.A.S. (1 ) New Dwelling H/YR •Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension Sq. Ft. O Setback to Lotline Setback to Right of Way O At Ft.** Setback to Ordinary High Water Level _ LL c,o Ft.yFt. XFt.**Ft. X Ft. X Ft.** Sq. Ft. Setback to Lotline __^ Setback to Right of Way Setback to Ordinary High Water^evel __ Elevation Above Ordinary Higb^Wate^J-evel Setback to Septic Tank / Setback to Drainfield / Setback to Bluff / Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No Ft.&Sq. Ft. Setback to Lotline___ Setback to Right of Way Setback to Ordinary High Water Level X Elevation Above Ordinary High Water Level Setback to Septic Tank -- Ft. Setback to Drainfie|d Setback to Bluff Maximum Proposed Hei^. ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft."Ft.&Ft.**Ft.& P Elevation Above Ordinary High Water Level '? -/* Ft. Setback to Septic Tank ^ Ft. Ft.**Ft." Ft.Ft. Ft. Setback to Drainfield ^ Ft. Setback to Bluff A/0 Ft. Maximum Proposed Height Ft. Basement_____ Walkout Basement Total Bedrooms Ft. Ft.Ft. Ft.\Ft. Yes /) No Yes Ft.Ft. ( ) Sqreen Porch ( ) Storage StructureV * Must include on scale drawing Permit may be required T^oqraphical Alteration / Earthmovino ^ None □ 20 Cubic Yards or Less *-□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT:V ^ /C,, f ’ Total Lot Area (FT^) /^/ f Bluff NoYesWafer FrontageLot Area. Impervious Surface Ratio:X100 = Impervious Surface RatioTotal Impervious Surface Onsite (FTr) T»\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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. f/o9/03.Date: Signature of f^bperty Owner Date: Lan6 &. Resource hAanagerr^nt Office <^o —/ITf'PERMIT FEE $RECEIPT NO.PROJECT(S) TOTAL SQ. R._ 'BnA V >*VTComments:6^ \/ ft / tU-rr^ 'hForm No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota r SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations mH Ft.Structure Set Back from Ordinary High Water Level no Ft. Ft.Structure Set Back from Top of Bluff Ft. Ft.Ft.Structure Set Back from Road Right of Way 4-Ft. &Ft.Ft.&Structure Set Back from Lot Lines Ft. Ft.Ft.Structure Height ^ 2^' Ft.Ft.Structure Set Back from Septic Tank Ft.Ft.Structure Set Back from Drainfield noEievation Of Lowest Fioor Above Ordinary High Water Level 3^Ft.Ft. Land Slope at Building Site %%I Inspector’s Comments /Sketch: / (<i.t L 0 O(' rs^ ')0 . BK Inspector's Signature /o Date of Inspection Time of Inspection Date/Initial Project Approved APFLICATIOli FOR SITE PERRfllT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE ■- Office . GOLDENROD - Inspector YELLOW - Owner (after issue) " PINR - Assessor PLEASE PRINT OR TYPE ALL INFORMATION Permit No. ; LAKE / RIVER NO.SECTION TWP NO.RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER CLASS jSTZ.- '2-II . parcel number (S)PROPERTY (E-911) ADDRESS S' 3 ^CPO -Z/o /ZJ> /r' LEGAL DESCRIPTION /C. <■ ^ ,^C-< f r Daytime Phone No.Mailing AddressLast Name First, "S?~ h^K'^ Initial / Contractor . Name Lie. # ik 1 •proposed project (please circle the appropriate number) (2) Add’n to Dwelling (5)RCU/Year____ ) ( 7 ) Add’n To Non-Dwelling (8) Storage Structure ( 9 ) W.O.A.S. 'Existing Dwelling to be removed before__ ONSITE WATER SUPPLY ^^(^i^dividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ^^ermlt No. 2-V '2-^^ ^ //g* 7^ , ( ) OTLSD * This permit is only valid after verification from the O.T.LS.D. that a conforming sewage system will be installed to service this lot contact Rome Mann at 864-5533. (1 ) New Dwelling'CE)>*Replacement Dwelling ( 6 ) Detached Garage ■ (10 ) Other . CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension__ ■ ’ ^Sq.^ . . Setback to Lbtline. r^ u Ft. & ■ Setback to Right of Wav r3?u ^ Ft." Setback to Ordinary High Water Level Ft. Elevation Above Ordinary High Water Level 4^^ Ft. )’. ■ Setback to Septic Tank /^ ' Ft- Setback to Draintield . ^ Ft. ■ Setback to Bluff hli7 Ft. ■ Maximum Proposed Height : ■ Basement, ■ '. Walkout Basement Total Bedrooms ^ CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension ; I Ft. X Ft."Ft. X Ft." Ft. X Ft." Sq. Ft.: Setback to Lotilne ___ Setback to Righm Way Setback to Ordinar^gh Watef Level __ Elevation Above Ordinafy^gh Water Level Setback to Septic Tan Setback to Drainfliffo Setback to Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No Sq. Ft. Setback toVotline Ft."Ft.&Ft."l&i Ft." Ft." Setback to Riwt of Way / Setback to Ordin^y Hiotrwater Level Elevation Above OiMary High Water Level __^ Setback to Seojic Tank Setback to/drainfield _ Setbaokro Bluff Ft." Ft..Ft. Ft.Ft. Ft.Ft. I Ft.iFt.Ft.3.No Yes ■ X No Yes Ft. Maximum Proposed Height ( ) Boathouse ( ) Gazebo Ft. ( ) Screen Porch ( ) Storage Structure **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / Inspection Ttyooraphical Alteration / Earthmovinq , '■ ^ None □ 20 Cubic Yards or Less * * Must Include on scale drawjng Permit may be required□ 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: Lot Area /Ci^AC Sq. Ft.^^No/OOckWater Frontage .Ft.Bluff Yes ^ z r1.Impervious Surface Ratio:xioo =.%Total Impervious Surface Onsite (FTs)Total Lot Area (Fp) -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. j Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. - Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express ' ■ . condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, ■ Minnesota. This permit may be.revoked at any time upon violation of said Ordinances. I understand that it is.my responsibility to inform the Land & Resource Manaj ice the building footings have been constructed.dl Signature of Pro^rty Owner Date:t //^ J2.9Date: Land & Resource Management Office Of-'7fgy eriy>-2.997RECEIPT NO.PROJECT(S) TOTAL SQ.FT.,PERMIT FEE $ u>) CXComments: Form No. BK — 0203-0501 313,012 • Victor Lundeen Co.. Printers • Fergus Palis, Minnesota APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE - Office * GGLDENROQ - Inspector YELLOW ■> Owner (after issue) PINK-Assessor PLEASE PRINT OR TYPE ALL INFORMATION TWP NAMESECTIONTWP NO.RANGELAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. //A Z2: I PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)! A l/C<3 3 c>i^0~Z-/o/2S'£’O^A AiLEGAL DESCRIPTION /C , ^ Jic.\f I Daytime Phone No.First Initial Mailing AddressLast Name iTProperty Owner A/jff/7 /l'/^ Contractor Name Lic.it ONSITE WATER SUPPLY J[3i)Jndividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( 5) RCU/Year_____ (8) Storage Structure _ 'Existing Dwelling to be removed before. (1) New Dwelling (Q')MH/YB^______ (7) Add'n To Non-Dwelling (10) Other (3) 'Replacement Dwelling (6) Detached Garage (9) W.O.A.S. ./Kll(y) Permit No. ( ) OTLSD * This permit is only valid alter verihcaSon from the O.T.LS.D. that a conforming sewage system will be installed to service this lot contact Rollie Mann at 864-5533. t CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension / v Ft. x. Sq.Ft. ^ Setback to Lotline (a Ft. & ^d? Ft.” Setback to Right of Way ^ Ft." Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level Setback to Septic Tank / (X Ft. Setback to Drainfield ^ Ft. Setback to Bluff ^ Y? Ft. Maximum Proposed Height Basement Walkout Basement__ Total Bedrooms___21 CHARACTERISTICS O^PROPOSED NON-DWELUNG Ft.x '< Outside Dimension / Ft.”Ft.” Ft. X Ft.” Sq. Ft. Setback to LotNne ___ Setback to Righfof Way A Sq.Ft._______ Setback to totline Setback to Right of Way / Ft.” 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 Appiication / inspection /Ft.”iF(;&Ft.” / Ft. Setback to Ordinary-High Wafer Level i^igh Wat FtFt. 3Elevation Above Ordinal Setback to Septic Ta^ ^__\ Setback to Drainfiefd___ Setback to Bluff_______ Maximum Proposed Height Bathroom Proposed.! ) Yes ( ) No er Level Ft Ft.Ft. Ft.Ft.Ft.ft-Yes No Ft.\X Ft.Yes No -7 ( ) Screen Porch ( ) Storage Structure ' Must include on scale drawing Permit may be required Topographical Alteration / Earthmovina □ None □ 20 Cubic Yards or Less ' □ 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: No/OOtA Bluff.Ft.Yes.Sq. Ft.Water FrontageLot Area. Impervious Surface Ratio:X100 =.% Impereious Surface RatioTotal Impervious Surface Onsite (FT:)Total Lot Area (FT») I ms IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. -ODate:/ Property Owner Date: _____________________ Comments: c, v yv <. TT Resource Management Office RECEIPT NO. f37PERMIT FEE $PROJECT(S) TOTAL SQ.FT. t-d . ^______Ca Uo/.' Form No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota r SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations y~i /-f ^ ?oStructure 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. /or- Ft. &Structure Set Back from Lot Lines Ft.Ft. & Structure Height Ft.Ft. Structure Set Back from Septic Tank Ft.Ft. T Structure Set Back from Drainfield • Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level 7^Ft.Ft. Land Slope at Building Site %%I Oait i MC(S M.^ • o Inspector’s Comments / Sketch:mil -V \Jiell w ^ nvs le ArfC Cenc^-ti- iJlrltwflJIk^Nce. T\0^d0^fhhfiT Pe I # 9 03 0 t • #!49 #' « # I 0o ■ # I 10' hm OHUC • E*€' 0 « diomf i# # dllUid Inspector's SignatureCe>dti~ Ah hi I do Date of Inspection Tkr^^ m SckIc.- I s^-3' Vui?T;cI<& HoNa hto^iz.oMirJil ‘Time of Inspection ^£a)iecl Appiwstt ------- • WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor APPLICATIOiy FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE / RIVER NO.LAKE/RIVER NAME SECTION TWP NO.RANGE TWP NAMELAKE/RIVER CLASS l/^<T PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) V 7. 3^0 ^^-3 <2> oo'T^/o / f LEGAL DESCRIPTION /6-f M Pt 4^ /Pt P~r q,l < t I Daytime Phone No. ■Last Name First Initial Mailing Address Property Owner Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate number) (2 ) Add’n to Dwelling (5) RCUA-ear , ( 7 ) Add’n To Non-Dwelling ( 8 )'Storage Structure ( 9 ) W.O.A.S. ‘Existing Dwelling to be removed before_ ONSITE WATER SUPPLY ^^^^^ndividual { ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure .setback to a well. ONSITE SEWAGE TREATMENT SYSTEM(^f^^eplacement Dwelling ( 6 ) Detached Garage : . (1 ) New Dwelling ;X) Permit ( ) OTLSD * This permit is only valid alter verification from'the O.T.LS.D. that a conforming . sewage system will be installed to service this lot contact Rollie Mann at 864-5533.(10) Other. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLINGOutside Dimension .y Sq.-Ft:,^______ . Setback to'Lotline Sd Ft. & Setback to Right of Way Ft." Setback to Ordinary High Water Level ' Elevation Above Ordinary High Water Level Ft. . Setback to Septic Tank /O Ft. Setback to Drainfield^U^ Ft. Setback to Bluff Ft. Maximum Proposed Height Ft. Basement_____ Walkout Basement Total Bedrooms ^ •7- Ft."Outsida\ Dimension'Ft.x Ft. X Ft." Ft. X T." Sq. Ft. Setback to Lotlilw ___ Setback to Right oVWay Setback to Ordinary ™h Water Lev^__ Elevation Above Ordinarwigh Vraer Level Setback to Septic Tank__ Setback to Drainfield__/ Setback to Bluff / Maximum Proposea Height Bathroom Proposed ( ) Yes ( ) No Sq. Ft._____\ Setback to Lotline Setback to Right of Way Setback to Ordinary HigtYWater Level Elevation Above Ordkiary HignSf/ater Level Setback to SepUdTank Setback to Drainfield Setback^Bluff_______ Maxirylm Proposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft."Ft.&Ft."[&Ft."F/"Ft."■I Ft.Ft. Ft..Ft.Ft.Ft. Ft. Ft.Ft...Yes_No Fr Ft.Yes No ( ) Screen Porch ( ) Storage Structure Topographical Alteration / Earthmovlnq*^l^one ' □ 20 Cubic Yards or Less * CHARACTERISTICS OF LOT: • Must include on scale drawing - Permit may be required□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More* 7^/Lr TACL Lot Area..Sq. Ft.Water Frontage .Ft.Bluff .Yes /(a, fAC^-■2.5“^1.Impervious Surface Ratio:X 100 =.% Total Impervious Surface Onsite (FTr)Total Lot Area (FTr)Impervious Surface Ratio ms 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, i, Permit: Permission is.hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express , condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail'County, i. .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 &urce Mai intjoffic^Mce the buiiding footings have been constructed. Date: _ Sigriature of l^perfyOwner 7-7-<7-oJ ■I' Date: _ Land & Resource Management Office PERMIT FEE $ -3^/0PROJECT(S) TOTAL SQ. FT.RECEIPT NO. 1^0-A Af>ffOs/-ecl e irv^hi:. Comments:U Form No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • .Fergus Falls, Minnesota o/C9 APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE- Office* GOLQEi^ROO - Inspector YELLOWr Owner (after issue) PINK - Assessor irmit/Jo.PLEASE PRINT OR TYPE ALL INFORMATION WM RANGE TWPAAISECTIONTWP NO.LAKE/RIVER NAME LAKE/RIVER CLASSLAKE / RIVER NO. 3^/V t- PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) o O O'T^/O / ZSoO r LEGAL DESCRIPTION /E-f Jc f>7 /\pT Pt G)L ‘Y * t f First Daytime Phone No.Initial Mailing AddressLast Name 1</C^7>(ynProperty Owner yy) jfAfe<fAy /y)iyA/s/?AyContractor Name Lic.« 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 PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( 5 ) RCU/Year_____ ( 8) Storage Structure _ 'Existing Dwelling to be removed before. (3 ) 'Replacement Dwelling (6 ) Detached Garage (9) W.O.A.S. r h'^11i di) MH/YR (7 ) Add’n To Non-Dwelling (10) Other____________ |X) Permit No. ( ) OTLSD * This permit is only valid alter verification from the O.T.LS.D. that a conforming sewage system will be installed to service this tot contact Rollie Mann at 864-5533. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLINGOutside Dimension Sq. Ft. Setback to Lotline ^ Ft. & Setback to Right of Way ^ Ft." Setback to Ordinary High Water Level J2^_^t. Elevation Above Ordinary High Water Level 7 Ft. Setback to Septic Tank / ^ ^ Ft. Setback to Drainfield Ft. Setback to Bluff Ft. Maximum Proposed Height Ft. BasementYes NoWalkout BasementYes 7^ No Total Bedrooms CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension/^ Ft. X 5 7 Ft."Ft. X Ft."Ft."Ft. X /Sq. Ft. Setback to Lotl])t^___ Setback to Right of.)/Vay Setback to Ordinary Hiqh Water Levql __ Elevation Above Ordinary'(;ligh W^ter Level Setback to Septic Tank Setback to Drainfield Setback to Bluff / Ft. Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No $0>\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 tp Bluff //Ft."Ft.&Ft.”U Ft."V Ft."VtFt.Ft. Ft.Ft. Ft.Ft. t.Ft. Ft. Ft. Maxinyjm Proposed Height ( ) Boathouse ( ) Gazebo Ft. t ( ) Screen Porch ■i ) Storage Structure "71 ■ /.-.2 **Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / inspection Topographical Alteration / Earthmovinq pX'None CHARACTERISTICS OF LOT: /L, 7a<- So. Ft. ' Must include on scale drawing Permit may be required□ 20 Cubic Yards or Less ' □ 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More' '7^ Lot Area,Water Frontage .Ft.Bluff .Yes /(/?. f/U".- 7-rImpervious Surface Ratio:xtoo =.%Total Impervious Surface Onsite (FT^)Total Lot Area (FT^)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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. /7' d5-'- ; ,Date: SignaXure of f^operiy Owner ./ Dkte:TO y't: i£-Land & Resource Management Office PERMIT FEE $PROJECT(S) TOTAL SQ..F;5i RECEIPT NO. Comments: ^ _____cx rrl.-f-Cx'hv^f-j |/^A ✓ C ^ V Form No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota % ^ SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations HJL 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. Ft. & f QA Ft.Structure Set Back from Lot Lines Ft.Ft.& /±LStructure Height Ft. Ft. Structure Set Back from Septic Tank Ft.Ft. Structure Set Back from Drainfield Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level 3 a Ft.Ft. Land Slope at Building Site %% LsiKe- Ciik f. ^A • o<( Inspector’s Comments / Sketch:ie)(i4 -V y^ii# lifeuViS ftCcNc^iT. # 7^' fm nml. Inspector's SignatureCede. - Ac til Date of InspectionC/uTn^uce tend Time of Inspection B Sciile- / s^-3' \lenfi‘c\e> Hone pd^ct Approved Date /Initial WHITE-Omce APPS^ICATION FOR SITE PERiyilT GOLDENROD - Inspector ^ RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) P^Nlf-AssTso7 ''W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us ;70 1^7'L^PLEASE PRINT OR TYPE ALL INFORMATION Permit No. • LAKE / RIVER NO.SECTION TWP NO.RANGE TWP NAMELAKE/RIVER NAME LAKE/RIVER CLASS !\fF PROPERTY (E-911) ADDRESS LEGAL DESCRIPTION o f (F-J. /./9 /<^ Daytime Phone No.Last First Initiai Maiiing Addressfme c'& Jy /F . Ma/. Property Owner Contractor ■ Name. , Lie. # PROPOSED PROJECT (please circle the appropriate n^ber) (1 ) New Dweliing (2 ) Add’n to Dwelling (i^]) (5) RCU/Year_____ ( 7 )'Add’n To Non-Dwelling ( 8) Storage Structure ; ('10 (Other ONSITE WATER SUPPLY (V) Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEMReplacement Dwelling ( 6 ) Detached Garage (9)W.0.A.S. (^- Permit No/-^/^-?C4^^/YR ( ) OTLSD * TTr/s permit is only valid after verification from the O.T.L.S.D. that a conforrhing sewage system wilt be installed to service this lot contact Ftollie Mann at 864-5533. \ 'Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLINGOutside ■ ^Dimension / V Ft. x Ft." , Sq. Ft. ^ Setback to Lotline ; . ' Setback to Right of Way Ft." 'Setback to Ordinary High Water Level Ft. Elevation Above Ordinary High Water Level Ft. > Setback to Septic Tank ^ Ft. ■ Setback to Drainfield ** Ft. Setback to Bluff Ft. Maxirhum Proposed Height' Ft. BasementYes ^ No Walkout Basement Yes ■ Total Bedrooms CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension Ft. X Ft. X _ Ft." Sq. Ft. \ Setback to LotlW___ Setback to Right oKWay Setback to Ordinary High Water U Elevation Above Ordinary Nigh'Water Level _ Setback to Septic Tank X Setback to Drainti^kl Setback to Bjpff_______ MaximupKProposed Height Bathroom Proposed ( ) Yes ( ) No Ft.&Sq. Ft. \ Setback to Lotlirife___ Setback to Right of >Way Setback to Ordinary Hi^Waj^ Level __ Elevation Above Ordinary/High Water Level Setback to Septic Tai Setback to Dralnfl^ Setback to Bluff/ Ft."Ft.&Ft.&Ft." Ft." Ft. •Ft.Ft. Ft.Ft, .Ft.Ft. Ft.A Maximum Praposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Right-of-yvays Must be Staked Onsite Prior to Application / Inspection Ft.No 4 ( ) Screen Porch ( ) Storage Structure * Must include on scale drawing Permit may be required T^oqraphical Alteration / Earthmoving P^^^one □ 20 Cubic Yards or Less * □ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: fA-XWater Frontage.Sq. Ft.Lot Area.Ft.Bluff .Yes No Total Lot Area (FT*) Impervious Surface Ratio:Xioo = Total Impervious Surface Onsite (FTr)Impervious Surface Ratio ms 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 perrnit is valid for a period of six (6) months. Permit:, Permission is hereby granted to the above named applicant to perform the work described in the above statement. This.permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota'. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resoufce Manapmei once the building footings have been constructed. Signature of Propertf Owner Date: , ■ Date: Land & Resource Management Office ------PROJECT(S) TOTAL SQ. FT.,PERMIT FEE $RECEIPT NO. '. Comments:C Form No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota •s. APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE -Offiee » " GOLDENRQli- Inspector YELLOW-r Owner (after issue) PINK - Assessor 70 577_lit No.PLEASE PRINT OR TYPE ALL INFORMATION SECTIONLAKE/RIVERLAKE / RIVER NO.LAKE/RIVER NAME LJ m-LfMBfR(S)^■^OPERTY (E-911)ADDRESSPARCEL N .rs- /I'or) - s/- aa/ ^2/. LEGAL DESCRIPTION 77^/Q. Mailing Address Daytime Phone No.First InitialLastme Property Owner Ufl<2r /Contractor Name 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 PROPOSED PROJECT (please circle the appropriate r^ber) (2 ) Add’n to Dwelling (\'^y ( 5 ) RCUA'ear_____ ( 7 ) Add'n To Non-Dwelling ( 8 ) Storage Structure (10 (Other Replacement Dwelling ( 6 ) Detached Garage (9) W.O.A.S. (1) New Dwelling ^) Permit No.. ^CUlmh/yr/^^^ ( ) OTLSD * Th/s permit is only valid after verification from the O.T.LS.D. that a conforming sewage system will be installed to service this lot contact Rollie Mann at 864-5533.'Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside DimensionFt.x"^ ^ Ft." Ft. X Ft." Ft. X Ft." Sq. Ft. Setback to Lotline_________ _______ Setback to Right of Way ^Ft." Setback to Ordinary High Water Level Ft. Elevation Above Ordinary High Water Level 2-Ft. Setback to Septic Tank ^ Ft. Setback to Drainfield Setback to Bluff Nr!) Ft. Sq. Ft. Setback to Lotllne____ Setback to Right dt.Way Setback to Ordinary High Water Level __ Elevation Above Ordinary t^h Water Level Setback to Septic Tank ^ Setback to Drainfield____ Setback to BJuff________ Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No \,Sq. FI. Setback to Lotlinq^___ Setback to Right of Way Setback to Ordinary High Water Level Elevation Above OrdinaryT-hgh Water Level Setback to Septic TanifL /Setback to Drainfield__ Setback to Bluff ;______ Maximum Pjdposed Height ( ) Boathouse ( ) Gazebo **Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection Ft."Ft.&Ft."Ft." Ft;" /Ft.Ft. Ft.Ft. Ft.Ft.Ft. .Ft. Ft.Maximum Proposed Height Basement______ Walkout Basement Total Bedrooms__ Ft.X Ft.Yes No =t.Yes A No Ft. 4 ( ) Screen Porch ( ) Storage Structure Tppographical Alteration / Earthmoving 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: /Mr) . /r!.7 Nve Yes NoSq. Ft.Lot Area Water Frontage .Ft.Bluff Impervious Surface Ratio:X100 =.%Total Lot Area (FT2)Total Impervious Surface Onsite (FT*)Impervious Surface Ratio ms IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. Date: of Prope^ Owner 2A.d... Date: /Z'po^yPROJECT(S) TOTAL SQ" ^ Labd & Resource Management Office PERUIT FEE $RECEIPT NO. Corpments: P ^ ^I~>a/IryH/V J \ Form No. BK — 0203-0501 313.012 • Victor Lundeen Co.. Printors • Fergus Falls. Minnesota »'SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations ■h -70Structure 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. Ft. & (01*- Ft.Structure Set Back from Lot Lines Ft.&Ft. r±Structure Height Ft.Ft. Structure Set Back from Septic Tank Ft.Ft. Structure Set Back from Drainfield 7^0 f-Ft.. . Ft. Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft. Land Slope at Building Site %%lOaitA^ia )--petjce— CuMf---^A • o Black Inspector’s Comments / Sketch: # Gv/Sn ililhA Cencftf-ti. Vife/e W fn», OWWi.,, Inspector's SignatureCe’d&~/^/r Date of InspectionZmTp,3HC£ ~^d3J m /sf = 3'Vefi-r/cl® No/i/e >. ^ ZOO Time of Inspection toject Approved Date/Initial APPLICATION FOR SITE PERNIIT Land & resource management, otter tail county (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us ■ WHITE-Office GOLDENRQD - Inspector YELLOVy - Owner (after issue) PINK' - Assessor Permit No.PLEASE PRINT OR TYPE ALL INFORMATION ■ LAKE/ RIVER NO.'LAKE/RIVER NAME RANGE TWP NAMELAKE/RIVER CLASS ^ ,MS JT) \3S \S9 jfusirLlMd:. PROPERTY (E-911) ADDRESS SECTION TWP NO. . ■ PARCEL NUMBER (S) - ■LEGAL DESCRIPTION Daytime Phone No.Last Name First Initiai Maiiing Address C-^. 1/ t // CAir'jy^Property Owner Contractor Name . 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 PROPOSED-PROJECT (please circle the appropriate number) (2 ) Add’n to Dwelling ■ ( 5 ) RCU/Year_____ (8 ) Storage Structure __ 'Existing Dwelling to be removed before ^^^^eplacement Dwelling (6) Detached Garage (9) w.o.A.s: (1 ) New Dwelling . ■ ( 7 ) Add’n To Non-Dwelling (10) Other ______ >4 Permit Nr^JV^ ( ) OTLSD * This permit is only valid alter verification ^ from the O.T.L.S.D. that a conforming sewage system will be installed to service this lot contact Rottie Mann at 864-5533.’ CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside .Dimension \ ' So.Ft.-7.Fy Setback to Lotline Setback to Right of Way JFt." ^ Setback to Ordinary High Water Level ^ Elevation Above Ordinary High Water Level ^Ft. Setback to Septic Tank /O Ft. Setback to Drainfield*^^ Ft. ■ Setback to Bluff Ft. . ■ Maximurh Proposed Height Ft. Ye s CHARACTERISTICS OF PROPOSED NON-DWELLING Outside c Dimension \Ft."Ft. X Ft. X Ft/' Sq. Ft. \ Setback to LotlinX________ Setback to Right of way____ Setback to Ordinary Hm Water Elevation Above Ordinar^igl^ater Level Setback to Septic Tank Setback to Drainfield Setback to Bluff Maxirrujm Pn Sq.Ft.I Sefback to Lotline _j Setback to Right of W Sefback to Ordinary Hig\ Watain.evel __ Elevation Above OrdinaryjjKgh Water Level Setback to Septic Tan Setback to Drainfi Setback to Blu _______ Maximum Proposed Height ■ ( ) Bi^ouse ( ) aazebo **Project/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. Basement_____ Walkout Basement____ Total Bedrooms No Height v \ Bathfboro^roposed ( ) Yes ( pNo Ft.Yes y* No Ft. ( ) Screen Porch ( ) Storage Structure V .Topographical Alteration / Earthmovinq ^[)^one □ 20 Cubic Yards or Less ' ': 'Characteristics OF lot ' Must include on scale, drawing Permit may be required□ 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More' NoLot Area q. Ft.Water Frontage .Ft.Bluff Yes Totai Lot Area (FT')Impervious Surface Ratio:X 100 .%Total Impervious Surface Onsite (FT*)Impervious Surface Ratio ms IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: l. 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 ariy plans and specifications submitted herewith shall become ' " ■ a part of this perrriit application. I also understand that this permit is valid.for a period of six (6) months. Permit: Permission is hereby ^granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express ‘condition that the person to whom it is granted,’and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, • • Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibiiity to inform the Land & Resource Manage offira once the buiiding footings have been constructed. f/r^fAS IDate;Signmj?e^P^e^wner2J>• Date: Land & Resource Management Office PROJECT(S) TOTAL SQ. FT.,PERMIT FEE $RECEIPT NO. i/Urv\ HComments: V (A- r' cX__ Form No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota /U'i o/^APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us WHITE - OfTige . * GOLDENROD - Inspector YELLOW.-Owner (after issue) PINK - Assessor 2t^y72-No.aPLEASE PRINT OR TYPE ALL INFORMATION NAMERANGESECTIOITWP NO.;LAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. i lao /fJ, /^7~> /~3Y'9' ^cy«rs-i2>i>t 31PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)t g3’ - 000-;i / - ^oo; LEGAL DESCRIPTION ■: Daytime Phone No.Mailing AddressFirst InitialLast Name CAU^fOProperty Owneri t. //a ffA/?THContractor Name Lie.# ONSITE SEWAGE TREATMENT SYSTEM Permit No,yj'/> g"'//5~7J ONSITE WATER SUPPLY y'} Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. PROPOSED PROJECT (please circle the appropriate number) (2 ) Add'n to Dwelling ( 5) RCU/Year_____ ( 8) Storage Structure _ 'Existing Dwelling to be removed before ^^^(^^Replacement Dwelling ( 6) Detached Garage (9) W.O.A.S. j (1) New Dwelling i; y^MH/YR^ I ( 7 ) Add’n To Non-Dwelling (10) Other ( ) OTLSD * This permit is only valid alter verificatkm from the O.T.L.S.D. that a conforming sewage system will be installed to service this lot contact Rollie Mann at 864-5533.! CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension //</F/"Ft. XFt." Ft. X Ft."r.2^Sq.Sq.Ft._____\ Setback to LotlinX^___ Setback to Right ot\jfay Setback to Ordinary Hi{(h Water^vel __ Elevation Above Ordinary'HIgtrWater Level Setback to Septic Tank Ft. Setback to Draintleld Setback to Bluff y Maximum Pissed Height \ \ Ft. Bathro^'Proposed ( ) Yes ( )^o Sq. Ft._______ Setback to Lotline Setback to Right of _ Setback to Ordinary Hig(i Elevation Above Ordinary High Water Level Setback to Septic Tan> Setback to Drainfiefd _ Setback to Blulf/Maximun^fbposed Height ( ) B^house ( ) Gazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / inspection Ft."Setback to Lotline Setback to Right of Way Ft." Ft.&Ft."FI.&,Ft.”'^t.Ft."Ft."Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level A Ft. Setback to Septic Tank/^ ^ Ft. Setback to Draintleld*^ ^ Ft. Setback to Bluff ^ Ft. Ft.Ft.Water LevelFt.Ft. /\Ft./Ft.Ft. Maximum Proposed Height Basement_____ Walkout Basement Total Bedrooms Ft.Ft.it.Yes No Ft.No ( ) Screen Porch ( ) Storage Structure i * Must include on scale drawing Permit may be required ■ Topographical Alteration / Earthmoving ^■None □ 20 Cubic Yards or Less *□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More* /CHARACTERISTICS OF LOT: Yes NoLot Arey^^ ^- '1:Sq. Ft..Ft.BluffWater Frontage 1.Impervious Surface Ratio:X100 .% Impervious Surface RatioTotal Impervious Surface Onsite (FT!) Total Lot Area (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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the buiiding footings have been constructed. (/ , tfDate: iignature of Property Owner•> X■n Date: /3'7oyyLand & Resource Management Office PROJECT(S) tot/S;CJO<00-PERMIT FEE $RECEIPT NO. g r <KVT KI .C<Comments: ! i X N. . -r Form No. BK — 0203-0501 313,012 • Victor Lurtdeen Co.. Printers • Fergus Falls. Minnesota SITE PERMIT INSPECTION RESULTS ' A Inspector must make all measurements and computations Structure Set Back from Ordinary High Water Level Ft. Ft. Structure Set Back from Top of Bluff Ft.Ft. Structure Set Back from Road Right of Way Ft.Ft. ^ji_^rFt. & ( O/^Ft.Structure Set Back from Lot Lines Ft. &Ft. /HStructure Height Ft. Ft. Structure Set Back from Septic Tank Ft.Ft. Structure Set Back from Drainfield . Ft.Ft. Elevation Of Lowest Floor Above Ordinary High Water Level y Ft.Ft. Land Slope at Building Site % %IQi-ftaya I --p»WC(£ L^/ns CitMp—j—A • Q p/ocjf Inspector’s Comments / Sketch: j \jeii 1 ovstt hani CencB^-ti. Uvir 1^' ffum om;. OMLl Inspector's Signature tZerde. ~ t'UkA If £/vrK3NiTi£ "^eaJLZj z^/oy’ Date of Inspection m Soile.- I s^-3' Vciff/’cle- HoN£ frle’^iz.e>/^ii-Jil // Time of Inspection Date/Initial i* ' ''Wh)'tE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor APPLlCATIOiy FOR SITE PERRHIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 www.co.otter-tail.mn.us PLEASE PRINT OR TYPE ALL INFORMATION Permit No. TWP NAMESECTIONTWP NO.RANGELAKE/RIVER CLASSLAKE / RIVER NO.LAKE/RIVER NAME k\ -e^o-d 3-7 PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS i s 3oc>P‘Z-/o/ 'LS'oO I Z Jc> o LEGAL DESCRIPTION /C ^ ? X/C^ P r (^LQL I \ ( t Daytime Phone No.First Initial Mailing AddressLast Name Property Owner _jy^dr/kContractor. ■. Name Lib.# PROPOSED PROJECT (please circle the appropriate number) (2 ) Add’n to Dweliing ) MH/YRyfy'f ( 5 ) RCU/Year ( 7 ) Add’n To Non-Dweiling ( 8 )'Storage Structure (io) Other: ONSITE WATER SUPPLY ;(^J^ndividuai ( ) Public ( ) None NOTE: MN Ruies Chpt. 4725 (MN Weii Code) requires a 3’ (minimum) structure setback to a weii. ONSITE SEWAGE TREATMENT SYSTEM P^Permit No. /! 37Z ( ) OTLSD * This permit is ortly vaiid after verificatiort from the O.T.LS.D. that a cortlorming sewage system wiii be instaited to service this lot corttact Rollie Mann at 864-5533. (1 ) New Dweiiing ((^’Replacement Dwelling ( 6 ) Detached Garage (9) W.O.A.S. 'Existing Dweiiing to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED DWELLINGOutside ' Dimension _ So. Ft.^ Setback to Lotline _ Setback b Right of Way ^ Ft.” Setback to Ordinary High Water Levei "^0 Ft. Elevation Above Ordinary High Water Levelj? ^ Ft. ,, Setback to Septic Tank Ft. , Setback to Drainfieid 4“ Ft. Setback to Bluff Ft.,Maximum Proposed HeiahL=y^^^ Ft. Yes CHARACTERISTICS OF PROPOSED NON-DWELLjNG Outside Dimension/y F,.Ft."Ft. X Ft." Ft. X Ft." Sq. Ft. \ Setback to Lotting___ Setback to Right of Way Setback to Ordinary Hi^ Water Le^__ Eievation Above OrdinaryNigh\Jrater Levei Setback to Septic Tank_ Setback to Drainfieid / Setback to Biuff • / Maximum Proposed Height Bathroom Prefposed ( ) Yes ( ) No Ft. & Ft."Sq. Ft. \______ Setback to^Lotiine ___ Setback to R^ht of Way Setback to OrdiiWy High Water Level .__ Elevation Above Orajn^ High Water Level Setback to Septic T^ Setback to Drainfieid Setback to Biu/___ Ft.&Ft."C&Ft."Ft/’ Ft.” Ft.Ft. Ft.Ft. Ft.Ft. Lt.Ft. Ft. Basement_____ . Walkout Basement___ • Total Bedrooms /g?- No Ft.Maximurn Proposed Height N. ( ) Boatf^^se ( ) Screen ( ) Gazebo Ft.Yes No ( ) Storage Structure **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection . Topographical Alteration / Earthmovinq None .□. 20 Cubic Yards or Less * ’ Must include on scale drawing Permit may be required□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More' RACTERISTICS OF LOT: /ki /0^ ^ Ft. /G'f XnoLot Area..Sq. Ft.Water Frontage Bluff .Yes Impervious Surface Ratio:X 100 =.% Total Impervious Surface Onsite (FTq Total Lot Area (FT^)Impervious Surface Ratio ms 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 vaiid for a period of six (6) months. Permit: Permission is hereby granted to the above named appiicant 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 ail 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 & Resourpg^Management ojfice oncpJhe building footings have been constructed./ Signature of PropertJuwner Date: _ Date: /5 7qVY Land & Resource Management Office rVo M-'■ PROJECT(S) TOTAL SQ.FT..PERMIT FEE $RECEIPT NO. Comments: ^ \cx^O^Y\^______[YY t'f_________________cv Form No. BK — 0203-0501 313,012 • Victor Lundeen Co., Printers • Fergus Faiis, Minnesota APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, OTTER TAIL COUNTY (218-998-8095) 121 W. JUNIUS AVE. SUITE 130, FERGUS FALLS, MN 56537 n.us WH/re - Office . ■ GOLDENROQ - Inspector YELLOW - Owner (after issue) PINK -^Assessor WWW. CO. otterjpi PLEASE PRINT OR TYPE ALL INFORMATION tE ~ SECTION TWP NO. RANGE TWP 'lo xnx. LAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. /<uiK-^i ; ./ .> ^A'i.^ 7- /f-too /■ RTY(E-911) ADDRESS'I?PARCEL NUMBER (S) S 3 ct - 2 JO I z.S'o'O {/ Z O LEGAL DESCRIPTION /C ^ x/ctP>r /t t Daytime Phone No.First ' ' ' Initial Mailing AddressLast Name Iaa^ £JProperty Owner _ii/tf/kContractor Name 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 PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling A’ (4 ) MHA'R /ff^ (5 ) RCUA'ear ( 7 ) Add’n To Non-Dwelling (8) Storage Structure (10) Other. (2) Add'n to Dwelling (3) 'Replacement Dwelling ( 6 ) Detached Garage (9) W.O.A.S. 7 ^ :>\ n s7iP'7) Permit No. i_ ( ) OTLSD * This permit is only valid alter verification from the O.TLS.D. that a conforming sewage system will be installed to service this lot contact Rollie Mann at 864-5533.'Existing Dwelling to be removed before.T CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELlING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING Outside Dimension // R. Ft.”Ft.”Ft. X Ft. X Ft.” /Sq. Ft. Setback to Lotline Setback to Right of Way Y Ft.” Setback to Ordinary Fligh Water Level O Ft. Sq. Ft. Setback to Lotlinb___ Setback to Right of Way Setback to Ordinary High Water Leyef __ Elevation Above Ordinary HjghJWater Level Setback to Septic Tank Ft. 5b 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/ ( ) Boatt)ouse ( ) Gazebo **Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.”Ft. & / Ft.”Ft.&Ft.”Ft.&Ft/' Ft.” Ft.Elevation Above Ordinary Hiph Water Level^ Setback to Septic Tank .Z/-' p( Setback to Drainfield Ft. Ft.Ft. Ft. Ft. Setback to Bluff Ft. Maximum Proposed HeiahLb<^^ Ft. Basement Setback to Drainfield Setback to Bluff .- Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No Ft. Ft. Yes NcYes 7^ No Ft.Ft.Walkout Basement Total Bedrooms ( ) Screen Poc^ ( ) Storage Structure Topographical Alteration / Earthmovinq 'Ll 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: ^ Ft Yes X No!Sq. Ft.Water Frontage BluffLot Area. /6X t fT1.Impervious Surface Ratio:X100 =.% Total Impervious Surface Onsite (R^)Total Lot Area (FT*)Impervious Surface Ratio ms IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibiiity to inform the Land & Resource Management office once the building footings have been constructed. Date:55l_£2iZ_ y. /■Date: Signature of Property Owner <■ - >3 "70VY Land & Resource Management Office , 0 <<PROJECT(S) TOTAL SQ.>T.\ X V^MPERMIT FEE $RECEIPT NO. /'VI H L-l; ■x i.i V (‘ 'txComments:__\y ('Bo A (/ Of / ry- Mi OJ V Form No. BK — 0203-0501 313,012 * Victor Lundeen Co., Prlrtters • Fergus Falls, Minnesota f- SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Structure Set Back from Ordinary High Water Level Ft.Ft.2) Structure Set Back from Top of Biuff Ft.Ft. Structure Set Back from Road Right of Way Ft.Ft./OQi- (Ft.&IStructure Set Back from Lot Lines Ft.&Ft.Ft. <? /*/Structure Height Ft.Ft. Structure Set Back from Septic Tank /'o ^Ft.Ft. Structure Set Back from Drainfieid Ft.. Ft. Elevation Of Lowest Floor Above Ordinary High Water Levei ?/-Ft.Ft. Land Slope at Building Site %% Liitke Cifinf A: ♦ • Q ^hcK dstjk Keeyvig-V y^ii Inspector’s Comments / Sketch: OveSif k( ■1g Walt n«' him om, . Mnf ■# OllUL i Inspector's Signature Cffde.- Ahlpif nnTf.3MCe Date of Inspection Tit^<s B ScJlU- /sfO'VcTft-,‘cl<& ti£>Ne /Zo^ Time of Inspection ^^^oject Approved Date/Initial X f\ % €) <ia?»*- ^ i i:S&>=^XT-^/C -f-iT -j^i _ •' ‘’•;t /O f '=>'« 4s /i>9^t^4^ (i)Al \"^£? ^ ^/#w4> ,,,^«.J^‘«fc4 iU ? 4. i ^ . ^ A J 4-5//‘^4-jSJaK,4^ 4/c? #>4tiJ=fe4§ / '■ ^--4 (i ^^^'VMi>'t>Wij!t-J;^t #^ %.f ie; (?>^-».- 5i-4l Ifeki?■'! ■r'” # #■ Jy> li ; Uiolp3> f ')'4^"^9^^ CjA^-^ ..2^_ Ci/^ /.-t-<4j _ ^®'’’‘t.., . .,S^^'V'^^&44^.^., /y)j‘l-^ ,.^^>*b ...,. 4*>;£*)*i^p£*^_........... ....... i>C<WWk«it^ , , i r^i r I , j . CM/tJ, „:., : muj^ ..M............................WPj ... i i T^rnu.........L;'. . .-■ .,,<^^>ep«\,. =^c J,...# i-!I V ■'■rf? J7 ; _ _ 'Sw4,.. ?.. 'a, . .'e^^'ii.':])....^.asfcW- 4r. ,4: ■.<s<-i2ar. , — ■■ .i^A^^iM^.-(^4i)- ) -! I!: «ifct»^6=>. 'rthTUJs , i> i '.t^.t,,is3tp^je>:4^ /VIH 4,.. i : i «*= / ?» t ■# : 1IwI t- 3^0 I 1;11III I i III!FeenTi^cc scALt^ 2,250 rr j. ioorrju^,T=r I I 1:1 ;[2H ufJifl]I1I32.^ -t I :!xkoaI 1!11I1( Pf« /nflP ' /fe.^ ficHi'ifiatA,i i I iI I I 1I/sT Tica - x),coo - loi, rr* I I I 1iIAI\1iI 1 .CT^! FT^ -7 to^ooo =• I !!\1 V 'I!^ ut4\n \ t ;i\(; 'A i;^ UHlTS y 5 /2f$* ^- U i ; : ; ;VjJ^ '2,0 IH Ut^iTS -X f '\'"s mm:...do 9JZ. /;lUiLb, %o' '■^i ^HD Tl(/i I'gfo' A 2c>6‘ 4 cP - ^7, 000 n"^ V'\1/L.oo : XJ' Q . 7'ci X'^'7,060 -. lUjCCo rr^/iJ^iT = P,l(,t7S^ O (j^>tS y /. S' A. ' !♦O UfjiTS m-VJ '.9i'■N/V v6®u^ 1;'■n/o u^fTS A./\v. -'■■•'I I '-■■'X I ■;V V;5.p ACf^ES-F/-4. "-i /TZ^m 9'A \ _\n p—? // i/ /ir - P^o - / -v' / X? k N,r*-' o ,i; In WiTsl /I\\ I <?> \o>y \<*s(B //,}?//\>\ Wt. ■' /Pi'yj^jai V \zr 4 ''<S I Vt,XDERSOrs LAND SDRVENIN _ 3' 3 SOUT:- .M;L'^ street FEIRG-US FAe'^S, MlNINiESOTA 5eS3‘7 C 2 ". S ) F 3 9 — 5 2 o 8 INC .M %\t \u' \\X ‘ s ’*‘*"’i[^1ii''i'i'-'-<-^-'^' sat-JJwaR- .'tBft.'v OKSflei ET. ■■ " ^ 1 grr'a—gsap"?^-'^ APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER.TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE-Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor I9U3PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE/RIV^ NAME RANGE TWP NAMELAKE / RIVER NO.LAKE/RIVER SECTION TWP NO. Ids 39 ' PARCEL NUMBER (S)PROPERTY (E-911) ADDRESS JkaA. My53000^/ <^^33 oo/'•*■1. LEGAL DESCRIPTION Daytime Phone No.Mailing AddressLast Name First Initial . 34d Ai rJ6) I . Lm/j Property Owner Contractor Name Lie.# .'' PROPOSED PROJEOT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( 5 ) RCUA'ear_____^ ( 7 ) Add’nTo Non-Dwelling ^^^torage Structure ,(10) Other. ONSITE WATER SUPPLY (l()'1ndividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM , (tnC. N, ( ) OTLSD * This permit is only valid am verification from the O.T.LS.D. that a conforming sewage system will be installed to service this lot contact Rollie Mann at 864-5533. (1 ) New Dwelling (4)MHWR_____ ■ (3 ) 'Replacement Dwelling (6) Detached Garage (9) W.O.A.S. ‘Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED DWELLING CHARACTERISTICS OF PROPOSED NON-DWELLING CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)n*l. <30r,. <4O .. Setback to Lotline ^ Ft. & yA3/0 Setback to Right of Way ^Ft.“ Setback to Ordinary High Water Level ___ Elevation Above Ordinary High Water Level *7 Setback to Septic Tank Setback to Drainfield Outside Dimension Setback to Lotline ____ Setback to Right of Way Setback to Orflinary High Water Level ___ Elevation Above Ordinary High Watej Levej Setback to Septic Tank___ Setback to Drainfield____ Setback to Blulf ■ Maximum Proposed Height ,. Basement.______ Walkout Basement Total Bedrooms__ Ft. X Ft."Outside Dimension _ Setback to Lotline ___ Setback to Right of Way Ft. 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 Appiication / Inspection FI.&FI."FI. X Ft." Ft."Ft.&Ft." -<^/^Ft.Ft.Ft."Ft. Ft.Ft. Ft.Ft. .Ft. 0 Ft.Ft. Ft. Ft.Setback to Bluff Maximum Proposed Height Bathroom Proposed ( Ft. Ft.No_Yes Ft. ) Yes ( Yes No i'Ft. ( ) Screen Porch ( ) Storage Structure . Topographical Alteration / Earthmovinq □ None .jif 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: Lot Area.• Water Frontage Ft.Bluff .Yes ■'.'Impervious Surface Ratio:X 100 =.% Total Impervious Surface Onsite (FT')Total Lot Area (FT^)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 applicatidri. I also understand that this permit is valid for a period of six (6) months. Permit: Permissiori is hereby granted to.the above named applicant to perform the work described in the above statement. This permit is granted upon express . coridition 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 Mana^mi Tc^^cethe building footings have been constructed. .Date:signatuKofpi^ y, Date: Land & Resource Management Office ' PERMIT FEE $RECEIPT NO. Comments: ■_ Form No. BK — 0500-0501 308,636 • Victor Lundeen Co.. Printers • Fergus Falls, Minnesota APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 WHITE ■ Office GOLDENROd - Inspector YELLOW - Owner (after issue) PINK - Assessor /9U3PLEASE PRINT OR TYPE ALL INFORMATION Permit No. LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWPNAME //I/a "/ t PARCEL NUMBER (S) PROPERTY (E-911) ADDRESS /aad /JuOO/ LEGAL DESCRIPTION '4 pt GlQ I3ai/)H(2^'( (:7. Last Name First Initial Mailing Address Daytime Phone No. //fdd /ntc C//)/if/^ _________________/hJxJ Property Owner y GC(f.J/P'd . 43 A {/ A /Contractor Name Lie.« ^ • ('K/ /r... PROPOSED PROJECT (please circle the appropriate number) (2 ) Add’n to Dweiling (5 ) RCU/Year______ 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 ./(1 ) New Dwelling (4 ) MH/YR_____ ( 3) 'Replacement Dwelling ( 6) Detached Garage (9) W.O.A.S. (1-) Permit No. ( ) OTLSD * This permit is only valid after verdkalm from the O.T.LS.D. that a conformirtg sewage system will be Installed to service this lot contact Rollle Mann at 864-5533. (7) Add'n To Non-Dwelling ; (8 ) Storage Structure (10) Other.'Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED DWELLING CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension_____ Setback to Lotline Setback to Right of Way /y'-' ^ Ft." Setback to Ordinary High Water Level Elevation Above Ordinary High VVater Level Setback to Septic Tank Setback to Drainfield , ' Ft. Setback to Bluff ' ///"Ft. 7^---- '2/Maximum Proposed Height ry ‘ ( ' Ft. Bathroom Proposed ( )Yes (4^No CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)Outside Dimension 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 Basement______ Walkout Basement Total Bedrooms__ Ft."Ft. X ^Ft."Ft. X 1 Outside Dimension 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_____ yd’it 4’Ft.&Ft."Ft.&Ft. X Ft." Ft."Ft.&Ft." Ft.-^Ft. 7__Ft. Ft."Ft. Ft.Ft.'/3 Ft.Ft.Ft. Ft.Ft. Ft.Ft. Yes No Ft. Yes No Maximum Proposed Height ( ) Boathouse ( ) Screen Porch ( ) Storage Structure Ft. ( ) Gazebo "Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Topographical Alteration / Earthmovinq □ None ' Must include on scale drawing Permit may be required□ 20 Cubic Yards or Less '□ 21 Cubic Yards - 299 Cubic Yards'□ 300 Cubic Yards or More' CHARACTERISTICS OF LOT:-l-//L'Ol) Ft.Yes ^ No^S'q.Ft.Lot Area.Water Frontage Bluff Impervious Surface Ratio:X100 =.% Total Impervious Surface Onsite (FT»)Total Lot Area (FT^)Impervious Surtace 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 condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed. Date:4^ Signature of Property Owner 1 . 'pdd'ti/ d/( yDate: Land & Resource Management Office/6 4p-PERMiT FEE $RECEIPT NO. L_ Comments: Form No. BK — 0500-0501 308,638 • Victor Lundeen Co., Printors • Fergus Falls, Minnesota SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Structure Set Back from Ordinary High Water Levei ^00 Ft. Ft. Structure Set Back from Top of Bluff Ft.Ft. Structure Set Back from Road Right of Way Ft.Ft./6 o'*' /oS Ft. &Structure Set Back from Lot Lines Ft.Ft.Ft.& Structure Height Ft.Ft. Structure Set Back from Septic Tank Ft.Ft. Structure Set Back from Drainfield Ft.Ft. Eievation Of Lowest Floor Above Ordinary High Water Level 3 +Ft.Ft. Land Slope at Building Site % % Inspector’s Comments / Sketch: •L^00 Inspector's Signature Date of Inspection Time of Inspection X'S'/C-o^Project Approved Date/Initial