HomeMy WebLinkAboutJulie Koski Et Al_56000080045000_Shoreland Permits_OTTER TAIL COUNTY
Grade & Fill Permit #_Miig
<PROPERTY OWNER e-V ___________
LAKE NO. '3tfS~ SEC. V TWP. NAME
LEGAL DESCRIPTION: CyU t .______________
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WORK AUTHORIZED Clo<v^ ^<Kv^A.
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NOTE; This card shall be placed in a conspicaous place not more than 4 feet above grade on the premises on which work
is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MANAGEMENT,
218-998-8095 WHEN AUTHORIZED WORK HAS BEEN COMPLETED.
1. EARTHMOVING SHALL BE DONE BETWEEN in-ZSt^\.r. &
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 implemented prior to any topographical alterations.
APPLICATION FOR GRADE & FILL PERMIT
LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL
GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537
218-998-8095
www.co.otter-tail.mn.us
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKE/RIVER #LAKE/RIVER NAME LAKE/RIVER
CLASS SECTION TWP. NO. RANGE TWP NAME
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PARCEL NUMBER(S)PROPERTY (E-911) ADDRESS
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LEGAJ^ESCRIPTION
Last Name First Initial Mailing Address DAYTIME Phone No./' 7 £> C^j// ^
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C/^c/e,Property
Owner
Contractor
Name
Lie. #
Date Stamp
NOTES: 1. The lotlines and project area(s) must be staked.
2. If project disturbs more than 1 acre of land you
are required to obtain a General Storm Water
Permit from the MPCA.
Ml'/2 2
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L&R Initial
PROJECT REQUEST (You may use the grid on back for required scale drawing):
DESCRIBE YOUR PROJECT(S):
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DETAILED INFORMATION:
AREA TO BE CUT/EXCAVATED:Yds^Ft. X Ft. - 27 =Ft. X
Length Width Ave. Depth
Yds^WALK-OUT BASEMENT PROJECTS:Ft. X Ft. X Ft. -27 =
Length Ave. Depth(Outside of the building foundation)Width
Yds^AREA TO BE FILLED/LEVELED:Ft. X Ft. X Ft. - 27 =
Length Width Ave. Depth
Yds^TOTAL EARTHMOVING REQUESTED =
BACKFILL AT FOUNDATION:Ft. Ft.
Max. Depth Distance From Foundation
CULVERT:If Yes, must indicate size and location on drawing.
Yes No
anned%IMPERVIOUS SURFACE:oo
SIGNATURE PROPfeRTY OW[^ER/AGENT FOR OWNER
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RECEIPT NUMBERDATE
BK062011
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;The scale drawing must be a signed drawing which includes and Identifies a graphic scale (feet), all existing and/or proposed structures, septic tanks,
drainfields, iotlines, road right-of-ways, easements, QHWLs, wells, wetlands, topographic features (i.e. bluffs), and onsite impervious surface calculations.:
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