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Home My WebLink AboutLake Region Recreational Center_46000990894000_Shoreland Permits_R^cr:vHD OCT 2 8 2004 4 WHITE-Office APPLICATION FOR SITE PERMIT GOLDENROD - Inspector YELLOW-Owner (after Issue) LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL PINK-Assessor GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 RESOURCE 218-998-8095 www.co.otter-tail.mn.us 2/P7TPermit No.PLEASE PRINT OR TYPE ALL INFORMATION RANGE TWP NAME ^ s? ITWP NO.SECTIONLAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. ^-2.Y'2-\nrrLf^r/)/L- \Gr> PROPERTY (E-911) ADDRESSPARCEL NUMBER (=> Last Name First Initial Mailing Address LE( Daytime Phone No. Property Owner Contractor Name Lie.# ONSITE SEWAGE TREATMENT SYSTEM ONSITE WATER SUPPLY ( ) Individual ^^ublic NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. PROPOSED PROJECT (please circle the appropriate number) (1 ) New Dwelling (4 ) MH/YR_____ ( 7 ) Add’n To Non-Dwelling ^^Storage Structure (10) Other. ( ) None( 3) 'Replacement Dwelling ( 6 ) Detached Garage (9) W.O.A.S. ( 2 ) Add'n to Dwelling ( 5) RCUA'ear______ ( ) Permit No. T^QOTLSD * 7/i/s permit is oniy vaiidalter verHicatiat / from the O.T.LS.D. that a ixmlorming sewage system witi be instailed to service this iot contact Ftoitie Mann at 864-5533.'Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED W.O.A.Sy (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING, Outside Dimension ’ ^ Ft. X Ft."Ft."Ft. X Ft. X Ft."/V(JSq. Ft. Setback to Lotline ____ Setback to Right of Way Setback to Ordinary High Water Le^___ Elevation Above Ordinary High ^Idter Level Setback to Septic Tank___ Setback to Drainfield ^ Setback to Bluff / Maximum Propospd Height Basement / Walkout ^ement Total Bm rooms__ Sq.Ft._, Setback to Lotline Setback to Right of Way ^ Ft." Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level ! Ft. Ft. O'! ^ Ft. Sq. Ft. Setback to Lotline ____ Setback to Right of Way Setback to Ordinary High Water L^l __ Elevation Above Ordinary Higtj/Water Level Setback to Septic Tank Setback to Drainfieli^ Setback to Bluff/ ^ *3- Ft. &Ft.&Ft."Ft."Ft."Ft.&FV* FIA'Ft. Ft.Ft. Ft.Ft. Setback to Septic Tank Setback to Drainfield Setback to Bluff Maximum Proposed Height Bathroom Proposed ( ) Yes Ft.Ft. Ft.Ft. Ft.Ft.Ft.NoYes Ft.Maximum ^posed Height ( ) Be4thouse ( jraazebo "Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Yes No ‘X No ( ) Screen Porch ( ) Storage Structure ' Must include on scale drawing Permit may be required Topographical Alteration / Earthmovinq ^gS.None □ 20 Cubic Yards or Less '□ 300 Cubic Yards or More'□ 21 Cubic Yards - 299 Cubic Yards' CHARACTERISTICS OF LOT: .Yes X'NoBluff.Ft.Water FrontageSq. Ft.Lot Area. T .%Impenrious Surface Ratio:X100 Ifrrpenrious Surface RatioTotal Lot Area (FT^)Total Impervious Surface Onsite (FT^) 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: »/iy OwnerSignature 0 ^Date: Land & Resource Management Offee ^ PERMIT FEE $ JT^.S0 RECEIPT NO.PROJECT(S) TOTAL SQ. FT.. Comments: 315,901 • Victor Lundeen Co., Printers • Fergus Falls, MinnesotaForm No. BK — 1003-0501 s 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 WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor ■ ■ -'■■►7? 2/P77Permit No.PLEASE PRINT OR TYPE ALL INFORMATION TWP NAMESECTIONTWP NO.RANGELAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. L ' ^ ' PARCEL NUMBER (5) ' ' ' ' OOij, LEGAL DESCRIPTION /^ i- Ltr y_PROPERTY (E-911) ADDRESS 5 VOff j y I 4. 4; .ir-<if*. ■ iDaytime Phone No.Initial Mailing AddressFirstLast Name 'P./j Ld)\ L/pProperty Owner it)A>i£. i CContractor Name Lie.# ONSITE WATER SUPPLY ( ) Individual (^jTublic NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM ( ) Permit No. OTLSD * This permit is onty-vaUd after verilication from the O.T.L^S.D. that a conforming sewage system wU be instaffed to service this iot contact Roilie Mann at 864-5533. PROPOSED PROJECT (please circle the appropriate number) (2 ) Add’n to Dwelling (3 ) ‘Replacement Dwelling (5) RCU/Year. ( ) None(1) New Dwelling (4) MH/YR____ (7 ) Add'n To Non-Dwelling Qg(J_Storage Structure (10) Other. ? ( 6 ) Detached Garage (9 ) W.O.A.S. «’ ‘Existing Dwelling to be removed before CHARACTERISTICS OF PROPOSED W.O.A.S. / (WATER ORIENTED ACCESSORY STRUCTURE) Outside Dimension CHARACTERISTICS OF PROPOSED NON-DWELUNG Outside Dimension CHARACTERISTICS OF PROPOSED DWELLING. Outside Dimension lA Ft. X ) Ft."Ft.“Ft. X XFt. X Ft."/AcSq. Ft. Setback to Lotline ___ Setback to Right of Way Setback to Ordinary High Water Level Elevation Above Ordinary High V)/ater Level Setback to Septic Tank / Ft. Setback to Drainfield _ Setback to Bluff Maximum Proposjarf Height Basement Walkout Balement Total Bedrooms _ Sq. Ft. Setback to Lotline Sq.Ft. Setback to LotlineSetback to Right of Way ^ ^ Ft.” Setback to Ordinary High Water Level /Ft.”Ft.&Ft."Ft.& 4___Ft.”FT* F4*Setback to Right of Way Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level Setback to Septic Tank y Setback to Drainfield Setback to Bluff.z Maximum Proposed Height ( ) Boathouse ( JflSazebo **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.■/ Ft.Ft.' <roElevation Above Ordinary High Water Level Setback to Septic Tank Setback to Drainfield Setback to Bluff Maximum Proposed Height _ Bathroom Proposed ( ) Yes Ft. Ft.Ft.Ft. /Ft.Ft.Ft.Ft.Ft.NoYes Ft.Yes No No { ) Screen Porch ( ) Storage Structure € ‘ Must include on scale drawing Permit may be required Topographical Alteration / Earthmovina EJ- None □ 300 Cubic Yards or More‘□ 21 Cubic Yards - 299 Cubic Yards‘□ 20 Cubic Yards or Less ‘ CHARACTERISTICS OF LOT: 2i3l .Yes X Not,.Bluff.Ft.:_LSq. Ft.Water FrontageLot Area. XlOO .%Impenrious Surface Ratio:Impervious Surface RatioTotal Lot Area (FTr)Total 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 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. r;r* ■-,Date:-^1Signature of Property Owner7-C/o/. / Date: gement Office^ (_^Land S Resource Manef^o 7^.RECEIPT NO.PERMIT FEE $PROJECT(S) TOTAL SQ. FT. Comments: % 315,901 • Victor Lundeen Co., Printers • Fergus Falls, MinnesotaX Form No. BK — 1003-0501 I SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations 7Structure Set Back from Ordinary High Water Level Ft.~ Ft. - Ft.Ft.Structure Set Back from Top of Bluff Ft./ OO ^Ft.Structure Set Back from Road Right of Way —Ft. &Ft.Ft. &Ft.Structure Set Back from Lot Lines Ft.Ft.Structure Height Ft.Ft.Structure Set Back from Septic Tank Ft.Ft.Structure Set Back from Drainfield Elevation Of Lowest Floor Above Ordinary High Water Level 7^Ft.Ft. Land Slope at Building Site %% ... ^ Inspector’s Comments / Sketch: _ m I Inspector's Signature 7 f/oY Date of Inspection Time of Inspection it'^^ct Approved iV White - Oflice Yellow — Owner Pink — Assessor Goldenrod InspecTtor SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT 1Permit No„LEGAL DESCRIPTION / "b Oj f\LoisAND LOCATION /nO Lake Classif._____ Sec. /nTrazrrPfTLwstr-aVz n-TTFeTAiri. Range TWP NameTWPLake No,Lake Name IDENTIFICATION: Please Print All Information First Zip No.Tei. No.Mailing Address— No. Street, City and StateInitiaiLast Name Ua l^eUlarJ r/g/y-fOwner a>firrL& NameContractor Architect Name. NON-RESIDENTIAL PROPOSED USE;RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT;y%f) New Building 0 Specify:,( ) One Family Dwelling ( ) Multipie Dweliing Units( ) Aiteration t>*^ther (( ) Other Size ESTIMATED COST OF IMPROVEMENT|$ DIMENSIONS:PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL; ( ) Mtfsonry (Wood Frame ( ) Structural Steel ( ) Other — Specify Basement: ( ) Yes ( Stories above basement: Sq. feet (outside dimension) Bedrooms No( labile (w/f Individual Septic Tank, etc. WATER SUPPLY: ( ) ^blic ( \Mndividual Well I BafRsTTT^. CHARACTERISTICS; I Maximum depth of lot feet.square feet. Water frontage is Building set back from high water mark is Land height above high water mark at building line is feet.Lot Area is xr feet. (Building Line) feet ,feet.feet — from road right of way isBuilding set back from St^te highway right of yfay Side yard is ............................. and ....,...s...Q.......feet. LQ .feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Sewage System Permit must be obtained before installation). Structure will be located Structure will be located Agreement; I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project. f a -^0'-?Q>Dated. Owner^^J?/.,^Sigri^ure of Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit: express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. /_________f V ^ Shoreland Management Official / ^ r. z-o- rc IDated Permit Fee $ 30 ■Receipt No. Comments: Form No. MKL-0286-019 229971@ VICTOR LUNDEEN CO.. PRINTERS, FERGUS FALLS. MINN. r White I — Office Yellow — Owner Pink — Asse^r Ooldenrod — Inspector SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT > /Permit No„LEGAL DESCRIPTION L j-i / , /) i! - ' ' A*-" 6L-I '/ tjAND LOCATION / TWP NameTWPRangeSec.Lake Classif.Lake NameLake No. IDENTIFICATION: Please Print All Information Tel. No.Zip No.Mailing Address— No. Street. City and StateInitialFirstLast Name Owner I NameContractor Architect Name. NON-RESIDENTIAL PROPOSED USE;RESIDENTIAL PROPOSED USE;TYPE OF IMPROVEMENT:/Specify:.( ) One Family Dwelling ( ) Multiple Dwelling y ' .I ) New Building ( ) Alteration , J Units .« f >( F'Other Size() Other ESTIMATED COST OF IMPROVEMENT $ DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME: Basement: ( ) Yes ( 1 No Stories above basement: Sq. feet (outside dimension) Bedrooms ( ) Public (. ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public ( .) Individual Well ( ) Masonry ( ^) Wood Frame ( ) Structural Steel ( ) Other — Specify / Baths ■i .1 CHARACTERISTICS;i -iti;J-f Maximum depth of lot feet.feet.Water frontage issquare feet.Lot Area is feet. (Building Line)Building set back from high water mark is.................... Land height above high water mark at building line is Building set back from State highway right of vyay..... Side yard is ..................... Structure will be located >feet .feet.feet — from road right of way is .............feet. .feet from septic tank (Sewage System Permit must be obtained before installation). feet from soil absorption system (Sewage System Permit must be obtained before installation). and / Structure will be located Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. THIS IS A SITE PERMIT ONL Y AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STA TE STA TUTES. I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project. I Dated. Signature of Owner Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit: express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated Shoreland Management Official Permit Fee $.Receipt No. Comments:I JForm No. MKL-0286-019 229971® VICTOR LUNOCEN CO.. PRINTERS. FERGUS FALLS. MINN. i % -■ -a INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 1 MINIMUM Shall Be 4 Sq. Ft Lot Area (Square feet)Sq. Ft,Sq. Ft. Water Frontage Ft.Ft. J ^Building Set Back from High Water Mark Ft.Ft. Building Set Back from State Highway Ft.50 Ft. Building Set Back from Street or Road Ft. 40 Ft. 30 & ^o' Ft.Side Yard &Ft. 0^Rear Yard Ft.Ft. Occupied Building to Septic Tank Ft.10 Ft. Occupied Building to Absorption System Ft.20 Ft. Elevation at Building Line above High Water Mark_____________Ft.3____^ Posl~3 Scd~Inspector's Comments: ' ■ i “S l/fnn (-pi2iBP Inspector'* Signature .vT"' i ,.i "i Title V-. Inspection Datedl;'1910- Agency VICTOa LUHDIIH I CO..\ White — Office Yellow — Owner Pink — Assessor Goldenrod Inspedtor SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone; (218) 739-2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT Pr- -4 .^ 4 Permit No..-..iLEGAL DESCRIPTION ■a./ -<> 9 /i4 AND ; LOCATION TWP NameTWP RangeLake Classlf.Sec.Lake No.Lake Name IDENTIFICATION: Please Print AM Information Tel. No-Zip No.Malting Address— No. Street. City and StateLast Name First Initial QC!'.Owner 5T -5) ^ NameContractor Architect Name, /NON-RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:/C^K SlrPl 'Specify:( ) One Family Dwelling ( ) Multiple Dwelling ( ) New Building ( ) Alteration \><Other fT)0VG.~(Dt\ Units ( ) Other Size ESTIMATED COST OF IMPROVEMENTS TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME:DIMENSIONS: Basement: ( ) Yes ( ) No( ) Masonry Wood Frame ( ) Structural Steel ( ) Other - Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public I ) Individual Well 'A"Stories above basement: Sq. feet (outside dimension) Bedrooms ..................................Baths Type of Roof: CHARACTERISTICS: feet. Maximum depth of lotWater frontage issquare feet.feet.Lot Area is Building set back from high water mark is....................... Land height above high water mark at building line is Building set back from State highway right of way.... Side yard is feet. (Building Line) /■5'.feet feet — from road right of way is feet. feet.and Structure will be located Structure will be located feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.). Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above se forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewitl shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 76. MINNESOTA STATE STATUES.Signature tsfi Owner Permission is hereby granted to the above named applicant to perform the work described in the above sta'Permit: express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail ent. This permit is granted upon the County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I fDated Shoreland Management Official Permit Fee $. Comments: 19S676(® VICTOR LUNDCEN CO.. PRiNTKRS, FERGUS FALLS. MINN.Form No. MKL-0771-002 7 •< '•White — Office Yellov|p — Owner Pink — Assessor Goldenrod v Inspector SHORELAIMD MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT i Permit No..LEGAL r I\DESCRIPTION 1\? Cx/, i'-' ' r /> ' ' T-.t...,-f .AND LOCATION :/ TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information Last Name Mailing Address— No. Street, City and State Zip No.Tel. No.InitialFirst Owner J NameContractor Architect Name. TYPE OF IMPROVEMENT;RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE; ( ) New Building ( ) Alteration ( ) One Family Dwelling ( ) Multiple Dwelling Specify: P UnitsV-<r>CX -! ( ) Other ( ) Other Size/I ESTIMATED COST OF IMPROVEMENTS PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL;DIMENSIONS: ( ) Masonry ( •) Wood Frame ( I Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY; ( ) Public ( ) Individual Well Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms Baths Type of Roof: CHARACTERISTICS: uda.Maximum depth of lot..............................square feet. Water frontage is Building set back from high water mark is.................... Land height above high water mark at building line is Building set back from State highway right of way..... Side yard is Structure will be located feet.Lot Area is feet. feet. (Building Line) LiP..feet LJl feet — from road right of way is ■feet. and feet. .feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.).Structure will be located Agreement; I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above se forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewit shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA ST A TE STA TUES.Signature of Owner ; Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit: express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. /■■■ ( f ■ i I ;\Dated Shoreland Management Official tPermit Fee $. Comments: 195676®Form No. MKL-0771-002 VIcrOS LUNDCEN CO.. PRiNTJ-r.c. FA. L S. ♦ INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 1 MINIMUM Shall Be 4 Sq. Ft, Lot Area (Square feet)Sq. Ft Sq. Ft. Water Frontage Ft.Ft. Building Set Back from High Water Mark Ft.Ft. Building Set Back from State Highway Ft.50 Ft. Building Set Back from Street or Road Ft.40 Ft. /<^ & Ft.Side Yard &Ft. Rear Yard Ft.Ft. Occupied Building to Septic Tank Ft.10 Ft. Occupied Building to Absorption System Ft.20 Ft. Elevation at Building Line above High Water Mark_____________Ft.3 Ft. \ Inspector's Comments: / / ^ ( Inspector's Signature Title Inspection Dated I 0 19 Agency V'CTOD UtNOECH 4 60 . MiHTEM. rCItOUO FALLI. HIHN SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY White — Office Yellow — Owner Pink — Assessor Goldenrod — Inspector ^/>9GL. ^ ^Permit No„5LEGAL ^ //^ J><rDate.DESCRIPTION AND LOCATION GO ^9 .-67 Yn^rTT;;. ) TWP NameLake Classlf.TWPLake No. Lake Name Sec.Range IDENTIFICATION: Please Print All Information Initial Mailing Address— No. Street, City and State Zip No.Tel. No.Last Name First ^Lc ■ C^IV>-A.Owner NameContractor Architect Name, TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE; A g-(O-New Building ( ) Alteration ( ) One Family Dwelling ( ) Multiple Dwelling Specify:. Units Size( ) Other ('Other ESTIMATED COST OF IMPROVEMENT $(omit cents) PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: (r-+lCiasonry ( ) Wood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public (->-tTidividual Septic Tank, etc. WATER SUPPLY: ( ) Public (,>-tTTdividual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central Basement: ( ) Yes (<^No Stories above basement: Sq. feet (outside dimension) Bedrooms 1. Baths HEATING: ( I Electric ( ) Gas ( ) Coal Other: Type of Roof:< ) Oil (-4-Nd (__)- None ( ) Unit ■3*CiO > S'G C>CHARACTERISTICS: Lot Area is square feet.Water frontage is . feet. (Building Line) ...............................feet feet. Building set back from high water mark is Land height above high water mark at building line is Building set back from State highway is Side yard is Building will be located Building will be located........ ___iSX?. ^0.1:.. feet — from road or street is feet. .^4C2..t y:.q.and feet. Rear yard is feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Orainfield, etc.). feet. zo.. 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. aSigiVture of Owner Dated. Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit: express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Shoreland Management Officiai^ Dated 7 State Surcharge $___Permit Fee $. Comments: Form No. MKL-0771-002 V>CT«a LUMDCCM 4 M.. a*«BTE«a, fCMUl r*LLI. VIMH.158899 r SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY White — Office Yellow — Owner Pink — Assessor Goldenrod — Inspector Permit No..LEGAL Date.DESCRIPTION AND :LOCATION TWP NameLake No.Lake Classif.TWP RangeLake Name Sec. IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address— No. Street. City and State Tel. No.Zip No. 1 Owner NameContractor Q \ fhXZ5*’ Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE: ( ) New Building ( ) Alteration ( ) One Family Dwelling ( ) Multiple Dwelling ( )Other Specify:, Units ( ) Other Size ESTIMATED COST OF IMPROVEMENT $(omit cents) PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry ( ) Wood Frame ( ) Structural Steel I ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY; ( ) Public ( ) Individual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central ( ) Yes ( ) NoBasement: Stories above basement: Sq. feet (outside dimension) Bedrooms Baths HEATING: I ) Electric ( ) Gas ( ) Coal Other: Type of Roof:( ) No ( ) Oil ( ) No ( ) None ( ) Unit CHARACTERISTICS: Lot Area is square feet.Water frontage is. feet. (Building Line) ................................feet . feet. Building set back from high water mark is.................... (.and height above high water mark at building line is Building set back from State highway is........................ Side yard is.................... Building will t>e located Building wiil be located feet — from road or street is feet. and .......................................feet. Rear yard is feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.). feet. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shali become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Dated. Signature of Owner Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit: express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated Shoreiand Management Official Permit Fee $.State Surcharge $. Comments; iForm No. MKL-0771-002 ^ VieT«R LUMBCiR i PMHTIII*. PEIIWS PMX*. HIMN 158899 1 INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 1 MINIMUM Shall Be 4-Sq. Ft. Lot Area (Square feet)Sq. Ft.Sq. Ft. Ft.Ft.Water Frontage Ft.Building Set Back from High Water Mark Ft. 50 Ft.Ft.Building Set Back from State Highway Ft.40 Ft.Building Set Back from Street or Road &Ft.Side Yard & Ft. Rear Yard Ft.Ft. Occupied Building to Septic Tank Ft.10 Ft. Occupied Building to Absorption System 20 Ft.Ft. Elevation at Building Line above High Water Mark_____________Ft.3 Ft. Inspector's Comments: spectovs Signature Title Inspection Dated Agency VICTO* UIHBCCH » M.. MtHTfl