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Home My WebLink AboutLeisure Lane Resort_50000990275000_Memos,Correspondences, File Notes_Department of LAND AND RESOURCE MANAGEMENT OTTER TAIL COUNTY Government Services Center • 540 West Fir Fergus Falls, MN 56537 Ph: 218-998-8095 Otter Tail County’s Website: www.co.ottertail.mn.us CLUSTER DEVELOPMENT PRE-APPLICATION MEETING NOTES Lc^$h4JL l/ytCluster Name: P/iAlitlC52. - Y'5'Lake Number: Lake Name: Rge. ^3Twp. ^ Property Owner: ^h) j' Sec. Who Attended: Discussion: (Sec. IV. 11.) p0^^pen Space j^/ZT^mpervious Surface ^/^T^wners Association ^^ja^'^esentation Requirements Land Surveyor, Civil Engineer or Architect ^ Tier Location Tier Area Pre-Plat Requirements (Sec. IV. 10. D.) DensiD^ Calculation Water Frontage _^^/-Wea ^ja'^uffer Zone ^P^oad Private —Public Street Parking ^ j C UfJW /^B'^^ru^re Setbacks Standard 1/2 Maximum Density Increases Cluster Development Meeting Notes Page 2 |0^'^^ntralized Sewage Treatment System uZf’^’^^Centr^ized Shore Recreation Facilities Dock(s) Swimming Area(s) v,0''^educed Visibility (Structures, Parking Area, & Other Facilities) j,,0^CU’s ■" 77> ____\Current Licensp- ____ OJ>eq^ec' ____ Storag^^ ^eT^PC pofisi^ations (Sec^V. 3.1.) Compatibility ^ Environmental Impact Hazards Density/Location Land Suitability ^ Parking/Traffic Noise Lighting Hours Lot Size Topographic Alteration Any other possible adverse effects j^ZT'^'^nvided copy of SMO ^0 Ft^ Max.) icture (20 Ft^ Max. & 6 Ft Max. Height) Dat(Signature i LODGING INSPECTION REPORT OTTER TAIL COUNTY ENVIRONMENTAL HEALTH County Court House Fergus Falls, MN 218-739-2271 56537 PAGE NUMBER: 1 1341 CLASS: LODG HAZARD RATING: L LEISURE LANE RESORT RR 2 BOX 120 56 OTTER TAIL PELICAN RAPIDS 56572 ALLAN & JANE KUNKEL LICENSE NUMBER: . ESTABLISHMENT NAME: ESTABLISHMENT ADDRESS: COUNTY: (218)863-4490 LICENSEE: INSPECTION NUMBER: MR971047 TIME: 17:07:15 SCORE: NUMBER: MR961068 TIME: 11:14:31 SCORE: INSPECTION TYPE: 1 ROUTINE 05/19/97 LAST PREVIOUS INSPECTION TYPE: 1 ROUTINE 05/28/96 100DATE: 100DATE: The following discrepancies are either previous orders from prior inspections or orders noted during this inspection. Compliance dates are shown for each item. Non-compliance with previous or current orders may result in suspension or revocation of your Lodging license. TOTAL SCORE THIS INSPECTION: 100 Thank you forYour establishment has received an acceptable rating, your hard work.Best wishes for continued success. NOTE: Plans and specifications must be submitted for review and approval prior to new construction, remodeling or alterations. I acknowledge receipt of the OTTER TAIL COUNTY ENVIRONMENTAL HEALTH inspection report Number MR971047 of 05/L9/97 . Signed:_^Represe^aO^Establishment Signed: MARK C. RONNING Environmental Health Consultant LODGING INSPECTION REPORT OTTER TAIL COUNTY ENVIRONMENTAL HEALTH County Court House Fergus Falls, MN 218-739-2271 56537 PAGE NUMBER: 1 1341 CLASS: LEISURE LANE RESORT RR 2 BOX 120 56 OTTER TAIL PELICAN RAPIDS 56572 DANIEL KRACHT LICENSE NUMBER ESTABLISHMENT NAME ESTABLISHMENT ADDRESS COUNTY LODG HAZARD RATING: LICENSEE: INSPECTION TYPE: 1 ROUTINE 05/28/96 LAST PREVIOUS INSPECTION TYPE: 1 ROUTINE 05/31/95 INSPECTION NUMBER: MR961068 TIME: 11:14:31 SCORE: NUMBER: MR951001 TIME: 10:28:40 SCORE: DATE:100 DATE:95 The following discrepancies are either previous orders from prior inspections or orders noted during this inspection. Compliance dates are shown for each item. Non-compliance with previous or current orders may result in suspension or revocation of your Lodging license. PREVIOUS ORDERS ISSUED 05/31/95 NOT IN COMPLIANCE: ITEM: 33 FIRE PROTECTION POINTS: 0 Repair smoke detectors to provide smoke detectors in an operable condition. COMPLIANCE DATE: 05/31/95 Contract with an approved fire equipment company to service all fire extinguishers annually in accordance with the requirements of the State Fire Marshal. COMPLIANCE DATE: 05/31/95 SPECIAL NOTES: Water sample taken from house hose bib. 1995 water test results were:<.05MG/L Nitrate, 0 bacteria. Sample taken today will be sent to MDH lab. Resort not open for season yet. Ensure that hot water temp, is set at 130F or below. TOTAL SCORE THIS INSPECTION: 100 Thank you forYour establishment has received an acceptable rating, your hard work.Best wishes for continued success. NOTE: Plans and specifications must be submitted for review and approval prior to new construction, remodeling or alterations. LODGING INSPECTION REPORT LEISURE LANE RESORT RR 2 BOX 120 INSPECTION DATE: PAGE NUMBER: 2 MR961068 TIME: 11:14:3105/28/96 I acknowledge receipt of the OTTER TAIL COUNTY ENVIRONMENTAL HEALTH inspection report Number MR961068 of 05/28/96 . Signed: Establishment Representative Signed: MARK C. RONNING Environmental Health Consultant LODGING INSPECTION REPORT OTTER TAIL COUNTY ENVIRONMENTAL HEALTH County Court House Fergus Falls, MN 218-739-2271 56537 PAGE NUMBER: 1 1341 CLASS: LEISURE LANE RESORT RR 2 BOX 120 56 OTTER TAIL PELICAN J5APIDS 56572 DANIEL KRACHT LODG HAZARD RATING:LICENSE NUMBER: ESTABLISHMENT NAME: ESTABLISHMENT ADDRESS: COUNTY: LICENSEE: INSPECTION TYPE: 1 fiCUT*?NE DATE: 05/31/95 INSPECTION NUMBER: MR951001 TIMt: 10:28:4a SCORE:95 The following discrepancies Are either previous orders from prior inspections or orders noted during this inspection. Compliance dates are shown for each item. Non-compliance with previous or current orders may result ia suspension or revocation of your Lodging license. ORDERS FOR COMPLIANCE THTS INSPECTION: ITEM: 1 BUILDING ^fi^IREMENTS: GOOD REPAIR, MAINTAINED POINTS: 3 Repair or replace damaged window frames and sashes throughout the establishment to be in sound condition. COMPLIANCE DATE: 05/31/95 Repair or replace damaged surfaces on the exterior ^ the building. This includes but is not limited to restoring exterior wall coverings, soffits, and facia to a good condition. COMPLIANCE DATE: 05/31/95 ITEM: 33 FIRE PROTECTION POINTS: 0 Repair smoke detectors to provide smoke detectors in an operable condition. COMPLIANCE DATE: 05/31/95 ■Contract with an approved fire equipment company to service all fire extinguishers annually in accordance with the requirements of the State Fire Marshal. COMPLIANCE DATE: 05/31/95 ITEM: 34 PLUMBING: INSTALLED, MAINTAINED POINTS: 2 All plumbing systems must be installed in accordance with the Minnesota Plumbing Code. LODGING INSPECTION REPORT LEISURE LANE RESORT RR 2 BOX 120 INSPECTION DATE: 05/31/95 PAGE NUMBER: 2 MR951001 TIME: 10:28:40 ========== = = = = = = = = = = = = = = = = = =:r= = = = = = = = = = = = = = = = = = = COMPLIANCE DATE: 05/31/95 SPECIAL NOTES: Annual water sample taken from Blue cabin, sample to be sent to MDH lab. Any noteable results will be provided to you immediately. Otherwise, a copy will be placed in your file when provided by MDH. TOTAL SCORE THIS INSPECTION: 95 The above inspection report is a summary of the Lodging Ordinance requirements and each violation noted has a weighted point value; the rating score is the point value total of the violations noted subtracted from 100. The completed inspection report specifies a period of time for correction of violations found. All violations shall be corrected the day of the inspection. Your establishment received an acceptable rating. NOTE: Plans and specifications must be submitted for review and approval prior to new construction, remodeling or alterations. I acknowledge receipt of the OTTER TAIL COUNTY ENVIRONMENTAL HEALTH inspection report Number MR951001 of 05/31/95 . Signed:’^ Establisr^entN^epresentative Signed: MARK C. RONNING Environmental Health Consultant / °' /OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH FERGUS FALLS, MN 56537 739-2271, Ext. 290 Page 2/^^zdYl’VDate: LODGING ESTABLISHMENT INSPECTION REPORT //<JOTime: UCENSEE CITVPRTOWNSHIP BUSINES^AME ..TYPE OF BUSINESS LICEtlSE NO.UNITS/ROOMS PHONE .^4 ?-s-3~yo POSTED ;? V/ ITEMS MARKED AND ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED REQUIREMENTS ITEM WT.REQUIREMENTS REQUIREMENTS ITEM WT.ITEM WT. BUILDING REQUIREMENTS INSECT, RODENTROOM FURNISHINGS 32Good repair, maintained 2 Clean good repair 28 Prevent entrance Professional ext. 1 15 TOILETS, SHOWERS 2 Health, safety, comfort 2 Provided each floor or room 29 Evidence present1654 PERSONAL HEALTH 3 One toilet and lav/10 One tub or shower/20 30 5 Handwashing practicesFLOORS17 Communicabie disease32 Construction, clean, good repair 31 2 CLEANLINESSDoors self-closing Rooms ventilated 18 1 3 Clean - free of rubbish, litterWALLS, CEILINGS 32 2 Clean, good repair proper construction 19 2 Clean, good repair Signs posted 4 FIRE PROTECTION Fire escapes accessible, good repair SCREENING WATER SUPPLY 20 7 Safe source52Doors, windows, openings screened. Other methods Exit signsHot water temp. 130“ F.21 4 Extinguishers present ‘^'Annually charged Egress from sleeping HAND WASHING LIGHTING, VENTILATION 22 1 Hot and cold / or equipment62Adequate lighting Smoke detectorsTowels / hand dryers7Ventilation, make-up 23 11 OtherGUEST ROOM UTENSILSair PLUMBING8242Multi-use, stored, washed properly, equipment 4 Heaters vented 34^ 2 III Installed, maintainedSPACE REQUIREMENTS Cross connections3559Single service, stored, dispensed 5 70 ft“ - 60 ft“ - 400 ft“25 1 ICE DISPENSING103 ft. bed separation1 Proper dispensing363WASTE DISPOSAL2At least 50% above gr.11 MCIAA373Sewage in accordance with M.P.C.A. Rules BEDDING • LINEN 26 7 12 2 Provided OTHER38Garbage and refuse Containers - storage area 13 2 Good repair, clean 32Changed between 2714 NOTE: PLANS AND SPECIFICATIONS MUST BE SUBMITTED FOR REVIEW AND APPROVED PRIOR TO BEGINNING ANY NEW CONSTRUCTION, REMODELING, OR ALTERATjONS TO THE PREMISES OR ITS FACILITIES. REMARKS AND ORDERSITEM Signatures RECEIVED BYPOSS. FIRE CODE VIOLATIONSRATING SCORE PUBLIC HEALTH i BSANITARIAN Yellow-EstablishmentDistribution: White-Agency Nelson Bros. Printing, Inc., Fergus Falls. MNOTH0019 OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH FERGUS FALLS, MN 56537 739-2271, Ext. 290 / o<IPage Date: / Q ‘f j' LODGING ESTABLISHMENT INSPECTION REPORT Time: LICENSEE 2. kixaJjr 3B.^WNSHIP r^ ^ J \ y ) OF BUSINESS ADDRESS CITY 0^./Z.'X-i^ 1^0 BUSINESS NAME TYP=E^F BUSINELEl5tt^E j^AjUb ^(ESO/Er UNITS/ROOMSPOSTED PHONELICENSE NO.3Y/S6J-i^9oS' ITEMS MARKED AND ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED REQUIREMENTS REQUIREMENTSITEM WT.ITEM WT.REQUIREMENTS ITEM WT. BUILDING REQUIREMENTS ROOM FURNISHINGS INSECT, RODENT 2 Good repair, maintained 3152Clean good repair 28 Prevent entrance Professional ext. 1 TOILETS, SHOWERS Health, safety, comfort2 16 2 Provided each floor or room 29 5 Evidence present4 PERSONAL HEALTH FLOORS 3 5 Handwashing practices17One toilet and lav/10 One tub or shower/20 30 2 I Construction, clean, good repair Communicable disease3312 I CLEANLINESS18Doors self-closing Rooms ventilated 1 Clean ■ free of rubbish, litterWALLS, CEILINGS 32 3 2 Clean, good repair proper construction 19 2 Clean, good repair Signs posted 4 FIRE PROTECTION Fire escapes accessible, good repair SCREENING 33WATER SUPPLY 7 Safe source5 2 Doors, windows, openings screened. Other methods 20 4 )Hot water temp. 130° F. 'Exit signs HAND WASHING Extinguishers present Annually chargedLIGHTING, VENTILATION 22 1 Hot and cold / or Egress from sleeping6 2 Adequate lighting equipment Smoke detectorsTowels / hand dryers7Ventilation, make-up 231 1 OtherGUEST ROOM UTENSILSair PLUMBING8242Multi-use, stored, washed properly, equipment Heaters vented4 2~^lnstalled, maintained 5 i Cross connections_______________ SPACE REQUIREMENTS 359570 ft' - 60 ft' - 400 ft'25 Single service, stored, dispensed 1 ICE DISPENSING103 ft. bed separation1 Proper dispensing363WASTE DISPOSAL2At least 50% above gr.11 MCIAA3Sewage in accordance with M.P.C.A. Rules 37BEDDING - LINEN 726 12 Provided2 OTHER38Good repair, clean Garbage and refuse Containers - storage area 13 2 Changed between 322714 NOTE: PLANS AND SPECIFICATIONS MUST BE SUBMITTED FOR REVIEW AND APPROVED PRIOR TO BEGINNING ANY NEW CONSTRUCTION, REMODELING, OR ALTERATIONS TO THE PREMISES OR ITS FACILITIES. REMARKS AND ORDERSITEM t Signatures POSS. FIRE CODE VIOLATIONS RECEIVED BYRATING SCORE PUBLIC health SANITARIAN \ Distribution: White-Agency Yellow-Establishment Nelson Bros. Printing, Inc.. Fergus FaJle, MNOTH 0019 OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH FERGUS FALLS, MN 56537 739-2271, Ext. 290 Page ) of / LODGING ESTABLISHMENT INSPECTION REPORT Time: yjTGO LICENSEE CITY OR JOWNSm?*ADDRESS TYP^F BUSINESS /r^so/er BUSINESS UNITS/ROOMS PHONELICENSE NO.POSTED ITEMS MARKED AND ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED ITEM WT.REQUIREMENTS ITEM REQUIREMENTS REQUIREMENTS WT.ITEM WT. BUILDING REQUIREMENTS INSECT, RODENTROOM FURNISHINGS 2 I Clean good repair2Good repair, maintained 31528 Prevent entrance Professional ext. 1 TOILETS, SHOWERS Health, safety, comfort2 Provided each floor or room4162 29 5 Evidence present PERSONAL HEALTH FLOORS 3 5 Handwashing practicesOne toilet and lav/10 One tub or shower/20 3017 3 } 2 Construction, clean, good repair 2 Communicable disease31 CLEANLINESSDoors self-closing Rooms ventilated 18 1 WALLS, CEILINGS 3 I Clean - free of rubbish, litter32 2 Clean, good repair proper construction 4 19 2 Clean, good repair Signs posted FIRE PROTECTION Fire escapes accessible, good repair___________ SCREENING WATER SUPPLY 33 2 Doors, windows, openings screened. Other methods 5 7 Safe source20 Exit signs214Hot water tern Extinguishers present Annually charged HAND WASHING LIGHTING, VENTILATION Hot and cold / or equipment 22 1 Egress from sleeping26Adequate lighting Smoke detectorsVentilation, make-up7 Towels / hand dryers1231 GUEST ROOM UTENSILS Otherair PLUMBING8Heaters vented 2 Multi-use, stored, washed properly, equipment 4 24 ^3A—rTT Installed, mainiainedSPACE REQUIREMENTS 5 I 70 ft= - 60 ft^ - 400 ft^Cross connections5359Single service, stored, dispensed 25 1 ICE DISPENSING103 ft. bed separation1 Proper dispensing3WASTE DISPOSAL 362 At least 50% above gr.11 3 MCIAA37BEDDING - LINEN Sewage in accordance with M.P.C.A. Rules 26 7 2 Provided12 OTHER38Garbage and refuse Containers - storage area 13 2 Good repair, clean 2 Changed between 31427 NOTE: PLANS AND SPECIFICATIONS MUST BE SUBMITTED FOR REVIEW AND APPROVED PRIOR TO BEGINNING ANY NEW CONSTRUCTIQN, REMODELING, OR ALTERATIONS TO THE PREMISES OR ITS FACILITIES. REMARKS AND ORDERSITEM r* Tt ,T I' IT ^ P'7— Signatures RECEIVED BYPOSS. FIRE CODE VIOLATIONSRATING SCORE PUBLIC HEALTH SANITARIAN Yellow-EstablishmentDistribution: White-Agency Nelson Bros. Printing, Inc., Fergus Falls. MNOTH 0019 OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH SUB OFFICE: 330 WEST MAIH PERHAM. MINNESOTA S6S73 MAIN OFFICE OHEB TAIL COUNTY COURT HOUSE FERGUS FALLS. MINNESOTA SS537 21J-739-Z27)LCDGING ESniBLISEI^ir I2EPBCTICM ESPCKP oocOTY ^T^P.-yr./cftTs f-TIMEP.O. ^ LILEctSEE ^4^ f_ ADDRESS i BUSINESS ^]A^e LICTIN5E NO* 7 -<✓/ r,-* .?•■i Af CITY OR TOWNSHIP TYPE OF aCSINESS yv^_fo.. r EST»LISro€Nr PHONE i e ' ^ <~c ^ CL /r^e i o c 7* PCBTED y3 ITE^S MARKED AND CBDERS WRITTEN BELOW MIST BE CD^f>LIED WITH BY DATE INDICAIED Numter of Roans REQUIREMENTS REQUIREMENTSREQUngMENTSWTITEMITEMWTITEMWT ROOM ETiailSHniGS DEBCT, RODENrBUILDING RBJJIREMENIS Clearly good repairGood repair, maiir- tained 2 23 TT2 Prevent entrance Professional ext.TTHTJgffS — fffTKJgRS Provided each floor Evidence present233162Health, safety, cotnfcct 42 PEkkj«u3r!Hor rocra One toilet and lavAO One tub or shower/20 3a 5 Handwashing practices CcmmLnicable disease rrgaAir.TTggg^ 17 TFL00B5 Ccnstruction, clean, good repair_______ 3T 2T2 Doors self-closing Rosins ventilated Xla Clean - free of rubbish, litter VlRirPkJi5411'iON' ■ WtflS, CSnJHGS 32 3 Clean, good repair Signs posted____I9Clean, good repair, proper construction 22 HMER SUPPLY 33 Fire escapes access- able, good repair SCREENING w Safe sourceOcors, windows, openings screened. Other methbds. 7 Hot water temp. 130 F Exit signs21452 Extinguishers present Annually chcurged Egress £ran sleeping ~ Smolce detectors BAND WASHINGHot and cold / or eqiipnent_______LicariNG, VEMTiiAncaAdeqiate lifting 22 T 6 2 Ttowels^Tiand dryersX2371Ventilation, make-up air GUEST RDCM 0TS^SI1£Other PEiSBINGMulti-use, stored, washed pro^rly/egiip Single s^vice, stored, dispensed 2Heaters vented 2484 2 Tnsrallpdf maintained34SPACE RBQDIHE^BaS 70 ft^-60 ft^00 ft7 35 5 Cross oonnections ICS OLSPO^iSG 25 X95 3 ft bed separation110 Proper dispensing363WASTE DISGSALAt least 50% above gr.11 2 Sewage in acoordance with RPCA Rules 37 IdAA7263BELDIHG - LINEN 12 Provided2 38 OTHERGarbage and refuse Containers-storage area Good repair, clean132 32714Changed between2 NOIE: PLANS AND SPECIFICA^O^B MIBT BE SCbMITTED FOR REVIEW AND APPRCVED PRIOR TO BEGINNING ANY NEW OONSTRDCTICN, FEMDDELING, CR ALTERATIONS TO THE PREMISES GR ITS BAdLITIES. REMiRRS AND ORDERSITEM /e ]'3> VT e s ? '>3 0 /■, 7^' z.^r// c i e .' n.'fS' <K./-f-7 C P,Rating Score ~// Pcss. Fire Code Violations Racei^ by Phone No.7J^'’ 5y7y Riblic Health Sanitarian OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH SUB OFFICE; 330 WEST MAIN PERHAM, MINNESOTA 56573 MAIN OFFICE omn TAIL COUNTY COURT HOUSE FERGUS FALLS. MINNESOTA 56537 218-739-2271 DCDGING BSI3»LlSId^S^ar DEFBCnnCN RgGRT EftTE -^LL . OOCNTYLIOEI^EE TUc/^. ADDRESS • 17.1 ____bUSlNESS ^g^^E ! Oq i/£vj? . i~ _ LICENSE NO. -^c4l /^^TIME / 6'P.O CITY OR TOWNSHIPf TYPE OF aCBINESS_J^^oIF EST»LISH^EM^ PHONEPOSTED ITEMS NARKED AND ORDERS WRITTEN bELCW MJST BE ODl«»LIED WITH BY DATE INmOMED Number of Rocms dT 1REQOIREMEiyrSREQUIPEMENISITEMWTFEQUIREMENTSWTITEMWTITEM ROOM POmiSHDIGSBUmaMG BBQQ]ngflcr, RODENT 2 Clean, good repearGood repair, maire tained 15 28 TX2 Prevent entrance Professicnal ext. : TVTTTJgrg - Provided each floorHecdth, safety, oorafott T6 2 29 5 Evidence present24 ! IffPERSOM^lor room 17 T One toilet and lavAO One tub or shower/20mxss 3a 3 Handwashing practices ; CannuTicable disease |Construction, clean, good repELir_________ T X 3T T8 X Doors self-closing Rooms ventilated fTJgAU.I Mgg; WALLS, CEILINGS Clean - free of3X3 rubbish, litterT9XClean, good repair Signs posted____ Clean, good repair, proper oonstructicn 4 X PTRS PRC713SLT1CM 33 Fire escapes access- able, good repair WSER SCFPLYSOEENING Doors, windows, openings screened. Other methods. xa 7 Safe source Hot water tenp. 130 F Exit signs5H42 Extinguishers present j Annually charged Egress from sleeping HAND WASHINGLiCTTiNG, vainiAncBAteqiate lifting XX Hot and cold / or eqaipnent________ X 6 2 Towels/hand dryers GDEST ROOM DTBNSI12 Skiolce detectorsVentilaticn, make-up air 23 171 Other PLLBfilNG242Multi-use, stored, washed properly,equip 3 Heaters vented4 TnstaTTpd, maintained34Xspace RhJJUlRH'«NTS 70 ft^U'ft^OO f€4 3 ft bed separation 25 35 5 Cross connections ICB OISPEZS^ 1 Single service, stored, dispensed 9 5 10 1 ;36 3 Proper dispensingUAt least 50% above gr.2 3ASTE mSPGBAL 377Sewage in accordance with ^^>CA Rules MdAA26BEDDIBG - LINEN 3 12 Provided2 OTHER13Good repair, clean Garbage and refuse Containers-storage area 332 327142Changed between NOIE: PIAtB AND SPBdPTCATIOlB MLBT BE SUBMITTED EX!« IE7IEW AND APPROVED PRIOR TO BEGINNING ANY NEW OONSTFDCTICN, FEMDDELING, OR ALTERATICNS TO THE PREMISES OR ITS BACtLITIES. R£M\RKS AND ORDERSHEM r\rr / p / j /}Ja /I ~i~Pv ^ /?O/g Receii^ bsn< ORating Soore PcBS. Fire Code Violations Fhone No.Rablic Health Sanitarian OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH SUB OFFICE: 330 WEST MAIN PERHAM. MINNESOTA S6S73 MAIN OFFICE OHEH TAIL COUNTY COURT HOUSE FERGUS FALLS. MINNESOTA 56537 218-739-2271 LODGUiG EST»LISB^e^a7 QCPE3CTIQN tSEBCRS TIME 3oocNrY_42f£M2iip.o. pf^j/AKj /^//)<; ____ LICEtSEE ijUiLUA/M ^ Pi^7TZy________ ADDRESS BUSINESS ^A^g 4£^/^Sc^£g• LAhJS LICENSE NO. DATE CITY OR TCWJSHIP TYPE CF BUSINESS ESTABLISH>ENr PHONE2ik.POSTED m>B tftRKED AND ORDERS VRITIEN BELOW MJST BE CDt«>LIED WITH BY DATE INDICATED Number of-fleGma- S Om/fJS. //ecA. REQUIREMENTS REQUIREMENTSFEQUIFEMENTS ITEM WT ITEM WTITEMWT ROOM PUEanSHINGSBUmiDiG RBQUIRB^E^IS DEBCT, RCDENT 2 Clean, good repairGood rep^dr, main tained 28 315X2 Prevent entrance Professional ext.TniTJgTS - fmWRPS Provided each floorT6 29 5 Evidence presentHealth, safety, oomfoct 42 n HT:.Pior rocra One toilet and lavAO One tub or shower/20 Handwashing practices . CainiLnicable disease T 51730PLOOBS 2Constructicn, clean, good repair_________ 3T23 Doors self-closing Rooms ventilated rr jaw. 1T5X Clean - free of rubbish, litter PIRE PHOiBCnON 3WAU£, CEILINGS 32 2 Clean, good repair Signs posted_____ Clean, good repair, proper a:xTStructicn T942 Fire escapes access- able, good repair HATER SUPPLY 33SOEENINS 20 7 Safe sourceDoors, windows, openings screened. Other methods. Hot water temp. 130 F Exit signs42152 Extinguishers present Annually charged Egress from sleeping ~ Smoke detectors HAND HASHING riot and cold / or eqiipment________ TLIGBnHNG, VEMTHAnCM Adeqiate li<jitinq 22 6 2 Ttowels/hand dryers GUEST ROOM UTENSILS 1237Ventilation, make-up air 1 Other PLUSING2Multi-use, stored, washed pro^rly,equip! Single s^vice, stored, dispensed_____ 24Heaters vented34 TnRtallpd, maintained2SPACE RBQaIBE^»aS 70 ft^-60'ft^Q0 f€7 3 ft bed separaticn 5 Cross connections ICB dispensing Proper dispensin'g 25 195 110 336At least 50% above gr.aASTB niSaBAL112 T Sewage in accordance with M>CA Rules 37 MdAA263BEUmiG - LINEN 12 Provided2 38 OTHERGarbage and refuse Containers-stocage area U Good repair, clean2 327142Changed between NOTE: PLAIB AND SPECIElCATIOtB MUST BE SCbMITIED PCm lEVIEW AND APPROVED PRIOR TO BEGINNING ANY NEW C3DNSTILCTICN, FEMDDELING, OR ACIERATICNS TO THE PREMISES OR ITS FACTLITIES. REMARKS AND ORDERSITEM LimJ tfUU ^mJu /JuJ. AjMM M/tdc niMJ t(^ fJrPudt, AJaS} t&b M(A^d6L (UiJJlL__________________________^^_____________ __________________________rJTiop^ 6>///P9-__________ /7,i n ARating Score Pass. Fire Code Violations RBceii«d by/7 SanitaLziaii^hiUll Riblic HealthRhone No. MINNESOTA DEPARTMENT OF HEALTi. Secrion of Hotels, Resorts and Restaurants 717 Delaware S.E., Minneapolis, Minn. 55440 PUBUC HEALTH and SAFETY INSPECTION RECORD y-/DATE OWNERP.O. ADDRESSLICENSEE /C^ y '-/ ■&P.O.ADDRESS /o y NO. OF EMPLOYEESy^y^/Scy'y-f' BUSINESS NAME Lie. NO. ^^3 POSTED , CABINS :S~,, UNITS, SLEEPING ROOMSNO. OF: BEDS TYPE OF BUSINESS Mobile Home Park and/or Recreational Camping Area Sites ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED ■_____________________/^J /y r x'Se^as? 3y- / V WELL - SEWER DIAGRAM , /?ZT7 Received by PuWic Health Sanitarvm COMPLIANCE PREVIOUS ORDERS YES NO DISTRICT OFFICES: Bemidji (7S5-3820). 2. .Mankato (389-2501). 3. Rochester (285-7289). 4. Duluth (723-4642). 5. Marshall (537-7151). 6. Mpls. (296-5335). 7. Fergus Falls (736-6922). 8. St. Cloud (255^216). COPIES - Central Office, Licensee. District Office y^r'fr 71 IE-00874-01 Mli.iMESOTA DEPARTMENT OF HEALTI Section of Hotels, Resorts and Restaurants 717 Delaware S.E., Minneapolis, Minn. 55440 PUBLIC HEALTH and SAFETY INSPECTION RECORD /C‘t) DATE \/^o j/ OWNERP.O. ADDRESSLICENSEE P.O,ADDRESS y^^ySOy^^ no. of employees-^^^^^ -BUSINESS NAME Lie. NO. C^3^07^, CABINS ^POSTED UNITS, SLEEPING ROOMSNO. OF: BEDS TYPE OF BUSINESS Mobile Home Park and/or Recreational Camping Area Sites ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED /u y^y yyyg'y^ y4d ^ y<2yy9 jyy'/yydy^ / 22.TySyy^yjypyyjyyi - WELL - SEWER DIAGRAM COMPLIANCE PREVIOUS ORDERS YES NO DISTRICT OFFICES. I. Hniiidii (7.SS-.^820). 2. Maiik.ito (389-6025). 3. Rochester (285-7289). 4. Duluth (723-4642). 5. Marshall (537 7151). 6. Mpis. (296-5335). 7. Fergu.s Falls (736-6922). 8. St. Cloud (255-4216). COPIES — Central Office, Licensee, District Office ^ ^jyC^ Received by MINNESOTA DEPARTMENT OF HEALTH Section of Hotels, Resorts and Restaurants 717 Delaware S.E., Minneapolis, Minn. 55440 SAFETY INSPECTION RECORDPUBLIC HEALTH AND ....^jQyip- P.o. DATE Oi'NERP.O. ADDRESSLICE.N’SEE address yy<P/-\sc^re ^ r NO. OF EMPLOYEESbusiness name Lie. NO., CABINSPO.STED NO, OF: BEDS_____, SLEEPING ROOMS , UNITS Mobile lIoTie Park and'or Recreacional Campin>> .Area Sices,type of busine.ss ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED 7^ WELL - SEWER DIAGRAM COMPLIANCE PREVIOUS ORDERS YES NO /A/ O2LDISTRICT OFFirES 1, -oini.-ii 7?5-.‘i820i 2. M .nk jto (,W'-r,i)25; .V Roche<.cer ,285-0178) .1. Duiuih f72i-4f>42! '. Marshal', i537 71 51 1 6. Mpl-, ^29{^•5'v’A\ 7. Fergus FaUs i'36-692:1 8. 5c. ■'loud i 25,3-42 1 •;■) Public Health Sanit^mnCOPIES - Central Office, Licensee. District Office •►w MINNESOTA DEPARTMENT OF HEALTH Section of Hotels, Resorts and Restaurants 717 Delaware S.E., Minneapolis, Minn. 55440 SAFETY INSPECTION RECORDPUBLIC EIEALTH AND ^2, /^^y?DATE CO.OXNERP.O. ADDRESSlicensee P.O.address yiS y^j c NO.OF EMPLOYEESBUSINESS NAME Lie. NO. V CABINS^5^POSTED ylyZ’NO. OF: BEDS_____, SLEEPING ROOMS., UNITS Mobile Hot.' Park arrd'or P.ecreational Campin^t Area Sites,type OF BUSINESS ORDERS WRITTEN BELOW MUST BE COMPLIED WITH BY DATE INDICATED y * ' ^ y^^lgy^fyyyyyys y. y-j-y ■yykJ2^ A ~7<^y yi o^y/y ]ey y2y/. /(yj^yA^ ------- / fy} y} y~e yf.nfc.y±/(Xec/.yy^>'^^yyi Ml ^nC;-y>^y>o’y’y) t 9.yyry7 y WEL^ SEW^ft QIAGRAM / COMPLIANCE PREVIOUS ORDERS YES NO \ ;DISTRICT OFFirE.s l-cin.-i-; 7.'3-.>820i 2. b^nkato (.IRU-oiUj; ,v Roche ..ter ,285-017«) J. l.Uiiu.h i72i-4r>42! '. Marshal! .'5J7 71 51 ! 6. .Mpl-. (29(>-5'v’Si 7. Fergus Falls i'36-69221 R. St. >''■"ad i 255-42 1 :■) RecelVM by Puhlic ricalth S^^#rftari^ ^ y-1 COPIES ■ Central Office, Licensee, District Office r OTTER TAIL COUNTY ENVIRONMENTAL HEALTH Otter Tail County County Court House Fergus Falls, MN 56537 218-739-2271 LICENSE RENEWAL NOTIFICATION Establishment: Address: LEISURE LANE RESORT RR 2 BOX 120 PELICAN RAPIDS, MN 56572KuiJiL£t- —BANFBL-KRACH? RR 2 BOX 120 PELICAN RAPIDS MN 56572 1341 (218)863--5^*U- Owner; Address: APPLICATION FOR RENEWAL This Notice of Renewal lists your current licenses to operate that are scheduled for renewal. All Annual Licenses must be renewed prior to January 10, 1997. Seasonal or new licenses must be purchased prior to opening for the season. The following late fees apply: 15% of license fee 25% of license fee 1-15 days late 16-30 days late After 30 days, the activity for which the license is required shall cease.amount due plus 25% late penalty fee. If a new license is approved, the fee shall consist of the Make Checks payable to OTTERTAIL COUNTY PUBLIC HEALTH. AMOUNT PAID CURRENT UNITS UNIT RENEWALUNIT CHANGES FEELICENSE TYPE TYPE 79.405SEASON UNITSLODG LODGING Renew Period; 01/01/97-12/31/97 WELL PRIVATE WELL Renew Period; 01/01/97-12/31/97 -24.ee- as. (301ANNUAL NUMBER OF WELLS $$$^65746' TOTAL PAID; ___lOM -MO___________TOTAL RENEWAL FEE DUE; OTTER TAIL COUNTY ENVIRONMENTAL HEALTH Otter Tail County County Court House Fergus Falls, MN 56537 218-739-2271 LICENSE RENEWAL NOTIFICATION Establishment: Address: 1341LEISURE LANE RESORT RR 2 BOX 120 PELICAN RAPIDS, MN 56572 (218)863-5590 DANIEL KRACHT RR 2 BOX 120 PELICAN RAPIDS MN 56572 Owner: Address; APPLICATION FOR RENEWAL This Notice of Renewal lists your current licenses to operate that are scheduled for renewal. All Annual Licenses must be renewed prior to January 15, 1996. Seasonal or new licenses must be purchased prior to opening. The following late fees apply: 15% of license fee 25% of license fee 1-15 days late 16-30 days late After 30 days, the activity for which the license is required shall cease.amount due plus 25% late penalty fee. Make Checks payable to OTTERTAIL COUNTY PUBLIC HEALTH. If a new license is approved, the fee shall consist of the AMOUNTUNITCURRENT UNITS UNIT CHANGES RENEWAL PAIDFEETYPELICENSE TYPE 77.005SEASON UNITSLODG LODGING Renew Period: 01/01/96-12/31/96 WELL PRIVATE WELL Renew Period: 01/01/96-12/31/96 24.001ANNUAL NUMBER OF WELLS $$$101.00 TOTAL PAID:TOTAL RENEWAL FEE DUE: JAM 0 512/19/94 PAGE: 1 OTTERTAIL COUNTY ENVIRONMENTAL HEALTH Ottertail County County Court House Fergus Falls, MN. 56537 218-739-2271 LICENSE RENEWAL NOTIFICATION Establishment: Address: 1341LEISURE LANE RESORT RR 2 BOX 120 PELICAN RAPIDS, MN 56572 *. DANIEL KRACHT RR 2 BOX 120 PELICAN RAPIDS MN 56572 Owner: Address: APPLICATION FOR RENEWAL This Notice of Renewal lists your current licenses to operate that are scheduled for renewal. Complete the enclosed form and return with the appropriate payment. All Annual Licenses must be renewed prior to January 15, 1995. Seasonal or new licenses must be purchased prior to opening. The following late fees apply: 15% of license fee 25% of license fee 1-15 days late 16-30 days late After 30 days, the activity for which the license is required shall cease.amount due plus 25% late penalty fee. Make Checks payable to OTTERTAIL COUNTY PUBLIC HEALTH. If a new license is approved, the fee shall consist of the RENEWAL AMOUNT PAID UNIT CURRENT UNITS UNIT NEW CHANGES EXPIRATION FEETYPELICENSE TYPE 74.80 23.00 5 12/31/95 12/31/95 SEASON UNITS ANNUAL NUMBER OF WELLS LODG LODGING WELL PRIVATE WELL 1 $$$$97.80 TOTAL PAID:TOTAL RENEWAL FEE DUE: L.' \ WORKERS COMPENSATION INSURANCE Minnesota Statutes Chapter 176.182 requires that you supply information concerning your Worker's Compensation Insurance, you employ anyone, complete items 1-4. paid or otherwise compensated employees, complete item 1. Sign/date where indicated. If If you do not have any Applicant Name; Worker's Compensation Insurance Company Name: 1. 2. Address of Insurance Company;3. Worker's Compensation Insurance Policy Number:4. • 7.nSIGNATURE:DATE: NOTICE Pursuant to Laws of Minnesota, 1984, Chapter 502, Article 8, Section 1 (270.72) (Tax Clearance.- Issuance of Licenses), the licensing authority is required to provide to the Minnesota Commissioner of Revenue your Minnesota business tax identification number and the Social Security number of each license applicant. Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of this information: This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employers withholding or motor vehicle excise taxes: Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement the Department of Revenue may supply this information to the Internal Revenue Service: FAILURE TO SUPPLY THIS INFORMATION MAY JEOPARDIZE OR DELAY THE PROCESSING OF YOUR LICENSE ISSUANCE OR RENEWAL APPLICATION. 1. 2. 3. £____K ____Applicant Last Name ______A-/- Z InitialFirst NameAs. City,ZipApplicant Address State Position (Officer, Partner, etc.)Applicant Social Security #/^ / 5 o/I/&sce:~f- • Business Namek h Ac o TCity Zipusiness Address State>eMinnesota Tax IdeTitification Number Signature /AjLUlP //AAl /Z-Date >ay } 2 1994 License No.: 341 Name: LEISURE LANE RESORT Owner: Addr: CSZ: KRACHT, DANIEL R. RR 2 BOX 120 PELICAN RAPIDS, MN 56572 Telephone: Operation: Lake Name: Water Supply: 863-5590 SEASONAL PRAIRIE LAKE PRIVATE Lodging - 5 Units Non-Community Public Water Supply - 1 Well 75.50 23.00 Types: Total Due and Payable 98.50 WORKMAN'S COMP INFORMATION (MUST complete if you employ outside help) APPLICANT NAME: NAME OF WC INSURANCE COMPANY: ADDRESS OF COMPANY: WC POLICY #: iSIGNATURE DATE FEE SCEEDULES PLACE OF REFRESHMENT or RESTAURANT: # OF EMPLOYEES LODGING; BASE FEE $62.00 FEE $70.35 $120.60 $180.90 $251.25 $301.50 # OF UNITS/ROOMS X $2.70 TOTAL FEE 1 4 5-18 19 - 28 29 - 35 36 and over $50.25 $23.00 LIMITED FOOD/BEVERAGE; WATER TEST FEE FOR 1994;I MOBILE HOME PARK or RECREATIONAL CAMP GROUND: YEAR-ROUND SEASONAL # OF SITES YEAR-ROUND 101 - 110 111 - 120 121 - 130 131 - 140 141 - 150 151 - 160 161 - 170 171 - 180 181 - 190 SEASONAL# OF SITES $170 $185 $200 $215 $230 $245 $260 $275 $290 $230 $250 $270 $290 $310 $330 $350 $370 $390 $20$30210 $35$501120 $50$702130 $90 $653140 $110 $130 $150 $170 $190 $210 $804150 $956051 $110 $125 $140 $155 61 70 8071 9081 ETCETCETC91 - 100 = = s = = = = = = = = = s = = s = = = == = = = = = = = = = = = = = = = =NOTICE: The information contained in this application becomes part of the County's OFFICIAZ RECORD and is thereafter accessible to the public. = = = r: = = = =: = = = = =: = = == = = = = =:=: = = = =: = =: = =. = = s == =:=:r: = = = =r = ===r = = =: = = == = = 1994 DEFINITIONS Due Date; All license f s are due PRIOR to Januar;^. of the year for which the application is made or PRIOR to the date of opening for seasonal or new establishment. New Business/New Owner: Opening after October 1 and before January 1, required to pay 1/2 of the normal fee.are Year-round; Over 6 months in calendar year. Seasonal: 6 months or less in calendar year. Penalty: 1-7 days late 8-30 days late -- 25% After 30 days, the activity for which the license is required shall cease. 15% If a new license is approved, the fee shall consist of the amount due plus 25% late penalty fee. Water Test Fee: EACH source of non-community water available for public consumption shall be tested. ALL persons, paid or unpaid, owner, lessee, working wife, not licensee's children under 18 years of age. is one full-time equivalent.) Employee: (40 hours per week Food and beverage service establishments includes drive-ins, bars, taverns, drive-in cafes, clubs, lodges, eating facilities at resorts, schools, day care facilities, children's camps, fairs, circuses, carnivals, public buildings, and all other businesses and establishments where meals, lunches, or drinks are served. Place of refreshment is a place where alcoholic beverages are served; or a place where only ice cream or soft drinks are served. Limited food service establishment means a food establishment serving only prepackaged food for example, • frozen pizza and sandwiches which receive no more than heat treatment. Mobile food service means a food service establishment that is a vehicle mounted unit, either motorized or trailered, and readily movable without disassembling, for transport to another location. Manufactured home park means any site, lot, field, or tract of land upon which two or more occupied manufactured homes are located, either free of charge or for compensation and includes any building, structure tent, vehicle or enclosure used or intended for use as part of the equipment of the manufactured home park. Recreational caunping area means any area, whether privately or publicly owned, used on a daily, nightly, weekly, or longer basis for the accommodation of five or more tents, or recreational camping vehicles free of charge or for compensation. Hotel-Motel shall mean a building structure or enclosure, or any part thereof kept, used as, maintained as, or,advertised as, or held out to the public to be an enclosure where sleeping accommodations are furnished to the public and furnishing accommodations for periods of less than one week. Boarding House shall mean every building or structure or enclosure, or any part thereof, used as, maintained as, or advertised as, or held out to be an enclosure where meals or lunches are furnished to five or more regular boarders, whether with or without sleeping accommodations, for periods of one week or more. Lodging House shall mean every building or structure, or any part thereof, kept, used as, maintained as, advertised as, or held out to be a place where sleeping accommodations are furnished to the public as regular roomers, for periods of one week or more, and having five or more beds to let to the public. Resort shall mean any building, structure, or enclosure, or any part thereof, located on or on property neighboring any lake, stream, skiing or hunting area for purposes of providing convenient access thereto, kept, used, maintained, or advertised as, or held out to the public to be an enclosure where sleeping accommodations are furnished to the public and primarily to those seeking recreation, for periods of one day, one week or longer, and having for rent two or more cottages, rooms or enclosures. LICENSE APPLir TION FOR FOOD, BEVERAG LODGING, MOBILE HOME PaRK, AND/OR RECREATIONAL CAMPING OTTER TAIL COUNTY PUBLIC HEALTH ENVIRONMENTAL HEALTH DIVISION COURT HOUSE FERGUS PALLS, MN 56537 218-739-2271, EXT 291 Print or type and check all applicable boxes. Incomplete or illegible applications will not be accepted and penalties may be assessed. NEW LICENSEAPPLICATION TYPE: RENEWAL /^So^ / ^ ^ LICENSE #.A-// AtAPPLICANT NAME /“f>n -f /: a Alt!.MN BUSINESS ID#_________ ESTABLISHMENT LOCATION: Z An^r- /^O /yc/9^^ /r?tO>^ S~6S~7^ ESTABLISHMENT NAME:■e A 5"^HIGHWAY/ROAD.LAKE/STREAM. ESTABLISHMENT MAILING ADDRESS: Z /<^qf P^Z/'r/U^ TELEPHONEcP/y-:S^6^- <7^90 OPENING DATE ^CLOSING DATE FIRE#/TOWNSHIP A-te/ ^ /^7/U- SrOT~P2- WINTER NUMBER (IF DIFFERENT) 7 HOURS AMOUNT (SEE BACK)TYPE OF LICENSE $.# OF EMPLOYEES. # OF SEATS_____ .RESTAURANT1. $.# OF EMPLOYEES. # OF SEATS____ PLACE OF REFRESHMENT2. $..LIMITED FOOD3. $..LIMITED BEVERAGE4. r5.%J7£TO_# OF UNITS.RESORT $.# OF ROOMS..HOTEL/MOTEL6. $.# OF ROOMS..BOARDING/LODGING7. $.# OF SITES.MOBILE HOME PARK8. $..RECREATIONAL CAMPGROUND # OF SITES.9. WATER: NON-COMMUNITY__/ WATER TEST FEE: # OF HOOK-UPS. # OF WELLS /MUNICIPAL g 7. > ^ SEWAGE: NON-COMMUNITY__/# OF HOOK-UPSMUNICIPAL $.PENALTY FEE: (if applicable) TOTAL DUE AND PAYABLE: WORKMAN’S COMP INTORMATION (MUST complete if you employ outside help) APPLICANT NA.MENAME OF WC INSURANCE COMPANY: ADDRESS OF COMPANY; WC POLICY #: SIGNATURE*^ . ' ^ iS. V __r- NOTE: This applicatiotTbecpnito part of the County's ch^FlCTAL ktcORD'ind is thereafter accessible to the public. DATE \ \ rev. 10/92 DEFINITIONS: Due Date; All license fees are due PRIOR lu January 1 of the year for which the application is made or PRIOR to the date of opening for seasonal or new establishment. New Business/New Owner Opening after October 1 and before January 1, are required to pay 1/2 of the normal fee. Year-round: Over 6 months in calendar year. Seasonal: 6 months or less in calendar year. Penalty; 1-7 days late — 15% 8-30 days late — 25% After 30 days, the activity for which the license is required shall cease. If a new license is approved, the fee shall consist of the amount due plus 25% late penalty fee. Water Test Fee: EACH source of non-community water available for public consumption shall be tested. Restaurant: Place where meals or lunches are prepared for service on premises or elsewhere. Place of Refreshment; Place where alcoholic beverages are served, or ice cream or soft drinks only are served. Limited Beverage/Limited Food: Place that sells only prepackaged food which receives heat treatment and is served in packages (ie: Stewart Sandwiches, Frozen Pizzas, etc.) or mobile units and concession stands serving foods and alcoholic beverages for 14 days or less in any one location. Hotel/Motel: Place where sleeping accommodations are offered for one night or more to transients. Resort: Place near recreational area, furnishing sleeping accommodations for one day, one week, or longer, and having two or more cabins, rooms, or enclosures. Boarding House: Place where meals or lunches are furnished to five or more regular boarders for periods of one week or longer. Lodging House: Place where sleeping accommodations are furnished to five or more regular roomers for periods of one week or more. Employee: ALL persons, paid or unpaid, owner, lessee, working wife, not licensee’s children under 18 years of age. (40 hours per week is one full-time equivalent.) FEE SCHEDULES LODGING:PLACE OF REFRESHMENT or RESTAURANT: # OF EMPLOYEES FEE $62.00 $70.35 $120.60 $180.90 $251.25 $301.50 BASE FEE 1 4 _____# OF UNITS/ROOMS X $2.70 TOTAL FEE 5-18 19 - 28 29 - 35 36 and over I LIMITED BEVERAGE: per EACH non-community water source/well. $50.25 $50.25LIMITED FOOD: $A?n.C'CWATER TEST FEE: MOBILE HOME PARK or RECREATIONAL CAMP GROUND: LICENSE FEES: # OF SITES YEAR-ROUND # OF SITES YEAR-ROUNDSEASONAL SEASONAL $30 $230 $250 $270 $290 $310 $330 $350 $370 $390 $170 $185 $200 $215 $230 $245 $260 $275 $290 $20210 101 - 110 111 - 120 121 - 130 131 - 140 141 - 150 151 - 160 161 - 170 171 - 180 181 - 190 $50 $351120 $70 $5021 30 $90 $653140 $110 $130 $150 $170 $190 $210 $804150 $955160 $110 $125 $140 $155 61 70 71 80 81 90 ETCETC91 - 100 ETC new business in FIRST YEAR ONLY # OF SITES PRIMARY LICENSE FEE: for # OF SITES FEEFEE $500 $600 $700 $100 $200 $300 $400 2 50 201 - 250 251 - 300 301 - 350 51 - 100 101 - 150 151 - 200 ETC ETC NOTICE: The information contained in this application becomes part of the County's OFFICIAL RECORD and is thereafter accessible to the public. License Application For Food, Beverage Or Lodging Establishment OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH Division of Environmental Health Courthouse Fergus Falls, Minnesota 218-739-2271, Ext. 290 56537 J o ir Print, type or check all applicable boxes, in complete and illegible applications will not be ac— cepted and penalties may be assessed. I New Licensee New Establishment Old EstablishoentApplication l^pe: Renewal SHIName of previews rerer: LUl 111 lAi 0 ^ \~Pi/'y\ /V Applicant Name: P/hn,^/ P K^AC-Uj- If Corporation, name of officers; Establishment Name: _ License# Social Security # MN Business ID # P/TXvrvtt IEstablishment Location: Lake/Stream (d l<,p. Hwy/RoadCity/Townsbip 1.1 'm. &x uiEstablishnent Mailing Address: TYffi GF LICIN5E # of seats # of txiits Restaurant (01) Resort (02) Limited Food (11) Tenporary Food Stand (11) ____^Place of Refreshnent/Beverage Service (10) ____fctel/Motel (02) Boarding/Lodging House (02) CT'23 # of seats # of rooms # of roems Carryout?Does establishment provide; Catering? Business hours SeasonalYear around Opening Date Closing Date 7Date Installed Date Installed Boat landing Water Supply Source: Mjnicipal Hmicipal Private o PrivateS>uay System: Other facilities if provided: Beach K Outdoor Pool Caiping )C -/ Indoor Pool XStore (^iS/)Winter nunfcer if different ( )Tele{^xxK ruber SEE REVERSE SIDE PGR FEE SCHEDUIE AND PENALTY SCHEDULE SCHEDUIZSDEFINITIOHS Due Date: All license fees are due prior to January 1 of the year for tdiich application is node or prior to the date of opening for seasonal or new establishment. New Business/New Owner: Hotel/Motel, Boarding House, Resort, Lodging House No. of Sleeping Roons, Units, and/or Cabins Fee # Units Lodging Fee '1^ U Q Penalty Base Fee $62.00 plus number of units, sleep ing room or cabins times $2.70 Place of Refreshment/Beverage No. of Employees Fee Opening after October 1 and before January 1st, are re quired only to pay one half (^) of the nomal fee. Penalty: A.l to 7 days late, a 131 f>enalty. B. Sto 30 late, a ISL penalty. C. After 30 days from the due date, the activity for «^ch the license is required shall cease. If a new license is approved, the fee shall consist of the amount originally due plus the 13L late penalty fee. Restaurant: Place where meals or luches are prepared for service on premises or elsewhere. Hotel/Motel :Place vhere sleeping accommodations are offered for one ni^t or more to transients. 41 $ 70.35 $120.60 $180.90 $251.25 $301.50 # of &iployees Beverage fee Penalty 5 18 19 - 28 29 35 36 and over Restaurant No. of Employees Fee 41 # of employees Food Fee Pena1ty_____ $ 70.35 $120.60 $180.90 $251.25 $301.50 5 18 19 - 28 29 - 35 36 and over Water Test Fee Limited Food and/or Beverage Service Fee Place of Place tdiere alcoholic beverages or Refreshment soft driidcs or ice cream only, are Food Fee $50.25 Fee $50.25 FeeBeverage:served.Beverage Fee Place near recreational area, furn ishing sleeping accommodations for one day, one week or longer and having two or more cabins, rooms, or enclosures. Place \diere meals or lunches are furnished to five or more regular boarders for periods of one week or more. Place vhere sleeping accoomodations are furnished to five or more r^ilar roomers for periods of one wedc or more. Eoqployee: All persons, paid or unpaid, owner, lessee, working wife, not licensee's children under 18 years. Place that sells only prepackaged food vdiich receives heat treatment and is served in the package (such as Stewart Sandwiches and frozen pizzas, etc.) or mobile units and concession stands serving food and/or alo^lic beverages for 14 days or less in any one location. 1981 Laws Chapter 346 requires that you supply us with information concerning your worker's com pensation insurance. If you enploy anyone, please complete items 1 through 4. Resort:Penalty TOTAL 1 NOTICE:The Information contained in this [ application becomes part of the county's] official record and is there after accessible to the public. IBoarding House: I MAKE CHECK PAYABLE TO: OTTER TAIL COUNTY HEALTHLodging House: Limited food and/ or limited beverage service: 1. Applicant Name: 2. Name of WC Insurance Company 3. Address of Company: 4. WC Policy Number: Your License can not be issued without this information. rmation on this application is correct.the^I certi J'/?- f2 DateSignature License Application For Food, Beverage Or Lodging Establishment OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH Division of Environmental Health Courthouse Fergus Falls, Minnesota 218-739-2271, Ext. 290 56537 , r I Print, type or check all applicable boxes, in- I complete and illegible applications will not be ac— I cepted and penalties may be assessed. Application l^pe: Renewal Name of previous owner; Applicant Name: If Corporation, name of officers: Establishnent Name: Establishnent Location; f P City/TGwnship_j^£j^C-^j^ Establishment Mailing Address; ^ ~ CL Sot 1^1 ~Pe / I c A M' /Pa- b New Establishnent Old EstablishmentNew Licensee /J _ License#*0'^ / Social Security # ~ / ttJ Business ID # t e Hwy/Roadl^ke/Streami M >/ n r7i.I b 5 TYPE CF LICENSE ____Restaurant (01) Resort (02) ____^Limited Food (11) ____Tenporary Food Stand (11) ____^Place of Refreshment/Beverage Service (10) ____^tel/Matel (02) Boarding/Lodging House (02) # of seats # of inits r’ # of seats # of rooms # of rooms Does establishnent provide; Catering? Business hours Carryout? Opening Date "^^9^ /I- *? / Closing Date 5 ‘t nT ' ^ SeasonalYear around Dace InstalledVfater Sqpply Source: Municipal Mmicipal Private Date InstalledPrivateSdkoge System: Other facilities if provided:Boat landingIndoor Pool Outdoor PoolBeach Store r'A-c(((g Caoping ^ S i ft c, Telephone ixnher Winter nnher if different ( ) SEE REVERSE SIDE FOR FEE SCNEIUIE PENALTY SCHEDULE rT£ SCHEDULESMFINITIQNS Hotel/Mstel, Boarding House, Resort, Lodging House No. of Sleeping Rooob, Units, and/or Cabins Due Date: All license fees are due prior to Janiary 1 of the year for tiilch application is node or prior to the date of opening for seasonal or new establishment. New Business/New CXaier: Fee # UnitsBase Fee $62.00 plus number of units, sleep- Lodging Fee 7D -r ing room or cabins times $2.70 Place of Refreshment/Beverage No. of Employees Fee Opening after October 1 and before January 1st, are re quired only to pay one half (^) of the normal fee. Penalty: A.l to 7 days late, a 133i penalty. B. Sto 30 (^E late, a 73L penalty. C. After 30 days from the due date, the activity for which the license is required shall cease. If a new license is approved, the fee shall consist of the amount originally due plus the 23L late penalty fee. Restaurant: Place vAiere meals or liKhes are prepared for service on premises or elseviiere. Hotel/Motel :Place vhere sleeping acconmodations are offered for one nig^t or more to transients. Penalty 41 $ 70.35 $120.60 $180.90 $251.25 $301.50 # of Eiiployees Beverage fee Pena1ty______ 185 19 - 28 29 35 36 and over Restaurant No. of Employees Fee 41 # of employees Food Fee____ Penalty_____ $ 70.35 $120.60 $180.90 $251.25 $301.50 5 18 19 28 29 - 35 36 and over Water Test Fee Limited Food and/or Beverage Service Fee/g//^f Place \diere alcoholic beverages orPlace of Refreshment soft drinks or ice cream only, are Beverage: Food Fee $50.25 Fee $50.25 Feeserved.Beverage Fee Place near recreational area, furn ishing sleeping accoonodatlons for one day, one week or longer and having tvo or more cabins, rooms, or enclosures. Place v^re meals or lunches are furnished to five or more regular boarders for periods of one wedc or more. Place viiere sleeping acconnodations are furnished to five or more re^ilar roomers for periods of one we^ or no re. All persons, p»id or impaid, owrer, lessee, working wife, not liceimee's children under 18 years. Place that sells only prepackaged food vhich receives heat treatment and is Resort:Penalty TOTAL IS.fa I NOTICE: The information contained in this application becomes part of the county's) official record and is there after accessible to the public. T Boarding House:III MAKE CHECK PAYABLE TO; OTTER TAIL COUNTY HEALTHLodging House: &iployee: Limited food and/ or limited served in the package (such as Stewart beverage Sandwiches and frozen pizzas, etc.) or mobile units and concession standsservice:serving food and/or alcoholic be\«rages for 14 days or less in any one location. 1981 Laws Chapter 346 requires that you supply us with information concerning your worker's com pensation insurance. If you enplqy anyone, please complete items 1 through 4. 1. Applicant Name: 2. Name of WC Insurance Company 3. Address of Company: 4. WC Policy Number: 0 H —OO Your License can not be issued without this information. ^ 0 ' 0- U f- I certify the information on this ^^plication is correct. DateSignature License application For Food, Beverage Or Lodging Establishment OTTER TAIL COUNTY DEPARTMENT Ot PUBLIC HEALTH Division of Environmental Health Courthouse Fergus Falls, Minnesota 218-739-2271, Ext. 290 56537 Print, type or check all applicable boxes, in complete and Illegible applications will not be ac- cepted and penalties may be assessed. III New Licensee New Establishment Old EstablishmentApplication Type: Reneual _ License# 3 ~/ / Social Security # SOS' - O 3 ~/5'9S~ _______ MN Business ID #___________ Name of previous owner; Applicant Nanoe: If Corporation, name of officers: Establishment Nanoe: Establishment Location; f f-g l~€L \ City/Township j Establishnoent Ibillng Address: !haT\ <1 -j-e-irn g . Pc-f f y Hwy/RoadLake/StreanICA ef 5L (birc /3il TYPE OF LICtNSE # of seats # of units Restaurant (01) Resort (02) Limited Food (11) Tenporary Food Stand (11) Place of Refreshment/Beverage Service (10) ___Hotel/Matel (02) Boarding/lodging House (02) r # of seats # of rooms # of rocms Carryout?Does establishment provide: Catering? Business hours X._ Opening Date yVAy, : Closing Date^^j/, / Date Installed__ Date Installed__ Boat landing SeasonalYear around -yWater Supply Source; Hmicipal Mjnicipal Private 7PrivateSeuige System: Other facilities if provided: Beach Indoor Pool Store 'TAc/zfe- Canpipg Outdoor Pool Telef^xme nunber (<^*^ )Winter luber if different ( ) SEE REVERSE SHE PCR FEE SCHEHJLE AM) PENALTY SCHEDULE ! ^ SCHEEUIESOEFINITIQKS HoCel/Mscel, Boarding House, Resort, Lodging House No. of Sleeping Roans, Units, and/or Cabins Due Date: All license fees are due prior to January 1 of the year for «diich application is nade or prior to the date of opening for seasonal or new establishnent. New Business/New Owner: Fee # Units -i$62.00 plusBase Fee number of units, sleep- Lodging Fee P 5~ ing room or cabins times $2.70 Place of Refreshment/Beverage No. of Employees Fee Opening after October 1 and before January 1st, are re quired only to pay one half (^) of the nomal fee. Penalty: A.l to 7 days late, a 13Zi penalty. B. Sto 30 c^E late, a 2351 penalty. C. After 30 days from the ckie date, the activity for vdiich the license is required shall cease. If a new license is approved, the fee shall consist of the amount originally due plus the 73L late penalty fee. Restaurant: Place tdiere meals or luches are prepared for service on premises or else«diere. Hotel/Motel :Place vfaere sleeping acconniDdations are offered for one night or more to transients. Penalty 41 # of Employees Beverage fee Penalty $ 70.35 $120.60 $180.90 $251.25 $301.50 185 19 - 28 29 - 35 36 and over Restaurant No. of Employees Fee 1 4 # of employees Food Fee Penalty $ 70.35 $120.60 $180.90 $251.25 $301.50 5 18 19 - 28 29 - 35 36 and over Water Test Fee Fee______ Limited Food and/or Beverage Service //-JR — Place of Refreshmsit soft drinks or ice cream only, are Beverage: Place vdiere alcoholic beverages or Food Fee $50.25 Fee $50.25 Feeserved.Beverage Fee Place near recreational area, furn ishing sleeping accommodations for one day, one week or longer and having two or more cabins, rooos, or enclosures. Place «dtere meals or lunches are furnished to five or more regular boarders for periods of one we^ or more. Place vdiere sleeping acccnmodations are furnished to five or more regular roomers for periods of one week or Resort:Penalty TOTAL ‘?S' 1NOTICE: The information contained in this application becomes part of tbe county's] official record and is there after accessible to the public. T IBoarding House: I i MAKE CHECK PAYABLE TO: OTTER TAIL COUNTY HEALTHLodging House: more. All {lersons, paid or unpaid, owner, lessee, working viife, not licensee's children under 18 years. Place that sells only prepackaged food vdiich receives heat treatment and is Eiiployee: Limited food and/ or limited served in the package (such as Stewart beverage service: Sandwiches and frozen pizzas, etc.) or mobile units and concession stands serving food and/or alcoholic beverages for 14 days or less in any one location. 1981 Laws Chapter 346 requires that you supply us with information concerning your worker's com pensation insurance. If you aiplqy anyone, please complete items 1 through 4. 1. Applicant Name: 2. Name of WC Insurance Company 3. Address of Company: 4. WC Policy Number: Your License can not be issued without this information. I certify the information on this plication is correct. DateSignature OHER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH SUB OFFICE; 222 2nd AVENUE S.E. PERHAM, MINNESOTA 56573 MAIN OFFICE OTTER TAIL COUNTY COURTHOUSE FER6US FALLS. MINNESOTA 56537 218-739-2271 ? LICENSE FEES - RENEWAL 341Lie. #OUfULEst. Name Phone #App. Name A gjJUJL Seasonal open & close Dates Address Our records, from Che calendar year 1988, show that your establishment operates as the following: FEES: # of employees # of employees Base # of Units Base # of Units Restaurant Place of Refreshment Resort Hotel/Motel Boarding/Lodging Base # of Units Limited Food Limited Beverage Childrens Camp MHP/RCA # of Sites c5cF>1Private/Municipal # of WellsWater Supply 9530TOTAL AMOUNT DUE PENALTY TOTAL AMOUNT DUE If our records are not accurate or if you are changing the operation of your establishment please let our office know as soon as possible. All license fees are due prior to January 1 of the year for which the application is made or prior to the date of opening for a seasonal or new establishment. Due Date: 1—7 day late 15^ penalty 8—30 days late 25^ penalty After 30 days the activity for which the license is required shall cease. PENALTY: OTTER TAIL COUNTY HEALTHMAKE CHECKS PAYABLE TO: YOU MUST SUBMIT PLANS FOR NEW CONSTRUCTION OR REMODELING FOR APPROVAL BY THIS DEPARTMENT BEFORE ANY WORK IS BEGUN. FEE SCHEDULES HOTEL/MOTEL, BOARDING HOUSE, RESORT, LODGING HOUSE; Base Fee — $62.00 Number of sleeping rooms, units and or cabins - 2.70 each. PLACE OF REFRESHMENT/BEVERAGE: No. of Employees;Fee: 1-4 $ 70.35 $120.60 $180.90 $251.25 $301.50 5-18 19-28 29-35 36 & over RESTAURANT: No. of Employees:Fee: 1-4 $ 70.35 $120.60 $180.90 $251.25 $30.50 5-18 19-28 29-35 36 & over LIMITED FOOD AND/OR BEVERAGE SERVICE: $ 50.25 $ 50.25 Food Fee Beverage Fee 1«)BILE HOME PARK/RECREATIONAL CAMPING AREA: PRIMARY LICENSE FEE: No. of Sites 2-50 51-100 101-150 Etc. $100 $200 $300 ANNUAL LICENSE FEES: Seasonal under 6 monthsNo. of Sites Year around over 6 months $ 20 $ 35 $ 50 $ 65 $ 80 $ 95 $110 2-10 11-20 21-30 31-40 41-50 51-60 Etc. $ 30 $ 50 $ 70 $ 90 $110 $130 $150 License ^PPlication For Food, Beverage Or Lodgi ng Estab I ishment OTTER TAIL COUNTY DEPARTMENT 01? PUBLIC HEALTH Division of Environmental Health Courthouse Fergus Falls, Minnesota 281-739-2271, Ext. 290 56537 r- Print, type or check all applicable boxes, in complete and illegible applications will not be ac- cepted and penalties may be assessed.III New Licensee Nw Establishment____Old Establishment )/.^iplication l^pn: Renewal 3ii_ License# Social Security # ^6^1 _________Business ID #________________ Naie of previous owner: Applicant Name: AMO F-P./?/\/ \'^TR."j If Corporation, name of officers:____________ Establishment Name: ilL\\lr IT IK I 1 — -VEstablishment Location: YR Pt-l City/Tcuaiship P-g, (c CA. N/ Establishnent Mailing Address: Hwy/Roadlake/Stream l?T % l?/Vjprt^5 A?A( ‘^LS‘7%^ TYPE CF LICENSE # of seats # of units Restaurant (01) Resort (02) lamited Food (11) Tenporaxy Food Stand (11) Place of Refreshment/Beverage Service (10) _____totel/Motel (02) Boarding/lodging House (02) # of seats # of rooms # of rooms Carryout?Does establishment provide: Catering? Business hours aSeasonal Opening Date Closing Date Year around Hater Supply Source: Municipal ^iJnicipal Private Private■Semgft System: Other facilities if provided: Beach Indoor Pool Outdoor Pool Boat landing CampingStore Winter nuoher if different ( )Telephone nuaher SEE REVERSE SUDE FDR FEE SCHEDUIE ^ PQIALTY SCHEDULE DEFINITICNS FEE SCHEDULES Hotel/Motel, Boarding House, Resort, Lodging House No. of Slewing Rocob, Units, and/or Cabins Due Date: All license fees are due pt^^r to January 1 of the year for application is made or prior to the date of opening for seasonal or new establishment. New Business/New Owner: Fee 1-18 19 - 35 36 - 100 101 and over $ 56.00 # Units $100.00 $130.oO $160.00 Penalty Lodging Fee Opening after October 1 and before January 1st, are re quired only to pay one half (^) of the nomHl fee. Penalty: A.l to 7 days late, a 1^ penalty. B. 8to 30 late, a 23%. penalty. C. After 30 days frocn the due date, the activity for ii^ch the license is required shall cease. If a new license is approved, the fee shall consist of the anount originally due plus the 2^ late penalty fee. Restaurant: Place tiiere meals or luches are prepared for service on premises or elseviiere. Hotel/Motel :Place «here sleeping accomnodations are offered for one ni^t or more to transients. Place of Refreshment/Beverage No. of Employees Fee 41 $ 52.00 $ 82.00 $118.00 $160.00 $190.00 # of Eiiployees Beverage fee Penalty 185 19 - 28 29 - 35 36 and over Restaurant No. of Employees Fee 1 4 $ 52.00 $ 82.00 $118.00 $160.00 $180.00 # of enployees Food Fee____ Penalty_____ 5 18 19 - 28 29 - 35 36 and over Limited Food and/or Beverage Service Food Fee Beverage Fee Place of Refreshment soft drirics or ice crean only, are Beverage; Place \diere alcoholic beverages or $ 40.00 Fee $ 40.00 Feeserved. Place near recreational area, furn ishing sleeping acconraodations for one day, one week or longer and having two or more cabins, rooms, or enclosures. Place viere meals or lunches are furnished to five or more regular boarders for periods of one wedt or more. Place «tere sleeping accoanodations are furnished to five or more regular roomers for periods of one week or Resort;Penalty TOTAL 1NOTICE: The information contained in this [ 1 application becomes part of the county's] I official record and is there after | jaccessible to the public.I Boarding House: MAKE CHECK PAYABLE TO: OTTER TAIL COUNTY HEALTHLodging House: more. All persons, paid or utpaid, cwner, lessee, working wife, not licensee's children under 18 years. Place that sells only prepackaged food t^ch receives heat treatment and is Employee: Limited food and/ or limited served in the package (such as Stewart beverage service; Sandwiches and frozen pizzas, etc.) or mobile units and concession stands serving food and/or alcoholic beverages for 14 days or less in any one location. 1981 Laws Chapter 346 requires that you supply us with information concerning your worker's com pensation insurance. If you enploy anyone, please complete items 1 through 4. 1. Applicant Name: 2. Name of WC Insurance Company 3. Address of Company: 4. WC Policy Number: Your License can not be issued without this information. I certify the information on this application is correct. - / V -DateSignature LICENSE APPLICATION FOR FOOD, BEVERAGE OR LODGING ESTABLISHMENT OTTER TAIL COUNTY DEPARTMENT PUBLIC HEALTH Division of Environmental Health Courthouse Fergus Falls, Minnesota 218/739-2271 56537 \ IPrint, type or check all applicable boxes, in- I complete and illegible applications will not be ac-| I cepted and penalties may be assessed. I I Old EstablishnentNew EstablishaentNew LicenseeAppl ication Type: Renewal ::3aLicense#Name of previous owner: Social Security #:Wi/Z/AM firhli) F'€RkIApplicant Name:I If Corporation, name of officers: I Minnesota Business ID #: Establishment name: pPf\riRi'<L Lhrl/'e^Establishment location: Hwy/RoadLahe/StreamCity/Township Establishment Nailing Address: Temporary StandCombinationRegular: Restaurant # of seats Resort # of units Limited Food/Temporary Food Stand Place of Refreshment/Severage Service # of seats . Hotel/Notel # of rooms Soarding/Lodging House # of rooms Total number of employees (See Definition) Does establishment provide Catering?Carryout? Business hours Year around Seasonal Opening Date: Closing Date: Water supply source:Nunicipal Private Sweage system:Nunicipal Private Other facilities if provided:Beach Outdoor pool Boat landingIndoor pool CampingStore Telephone number ( )Winter number if different () « « FEE SCHEDULESOEFINI nONS 35 36- 100 101 and over HOTEL/HOTt., BOARDING HOUSE, RESORT, LOGGING HOUS; No. of Sleeping Rooas, Units, :r.d/or Cabins DUE DATE: All license fees are due pi .or to January 1 of the year for which application is aade or prior to the date of opening for seasonal or new establishaent. PENALTY: A. 1 to 7 days late, a 15% penalty. B. 8 to 30 days late, a 25% penalty. C. After 30 days froe the due date, the activity for which the licnese is- required shall cease. If a new license is approved, the fee shall , consist of the aaount originally due plus the 25% late penalty fee. RESTAURANT: Place where aeals or lunches are prepared for service bn premises or elsewhere. HOTEL/ROTEL: Place where sleeping accomodations are offered for one night or aore to transients. Fee $ ^00 $ 90.00 $120.00 $150.00 Lodging , Penalty__________ cX- PLACE OF REFRESHNENT/BEVERAGE No. of Eaployees 1 - A 5 - 18 19- 28 29- 35 36 and over Fee $ A2.00 $ 72.00 $108.00 $150.00 $180.00 Penalty Beverage fee RESTAURANT No. of Eaployees PLACE OF REFRESHNENTS. soft drinks or ice creaa only, are BEVERAGE RESORT :Place where alcoholic beverages or Feeserved. :Place near recreational area, furn ishing sleeping accoaaodations for one day, one week or longer and having five or aore cabins, rooas,, or en closures. :Place where aeals or lunches are furnished to five or aore regular boarders for periods of one week $ 42.00 $ 72.00 $108.00 $150.00 $180.00 Penalty 1 A 5 - 18 19- 28 29- 35 36 and over Food fee BOARDING HOUSE LINITEO FOOD ANO/OR BEVERAGE SERVICE $ 30.00 FeeFood Fee $ 30.00 FeeBeverage Feeor aore. :Place where sleeping accoaaodations are furnished to five or aore regular rooaers for periods of one week or aore. LOGGING HOUSE Penalty TOTAL I NOTICE:The inforaation contained in this ape I becoaes part of the county's official upon receipt by the agency and is thi after accessible to the public.______ ENPLOYEE :A11 persons, paid or unpaid, owner lessee, working wife, not licensee's children under 18 years.ILINITEO FOOD Place that sells only prepackaged food ANO/OR BEVERAGE which receives heat treataent and is served in the package (such as Stewart Sandwiches and frozen pizzas, etc.)or- ■obile units ano concession stands serving food and/or alcoholic beverages for lA days or less in any one location. NAKE CHECK PAYABLE TO: OTTER TAIL COUNTY HEAL'- SERVICE (Date)(Applicant Signature) 1981 Laws Chapter 3A6 requires that you supply us with inforaation concerning your worker's compensation insurarce. If eaploy anyone, please conplete iteis 1 through A. If you do not have any paid or otherwise coapensated eaployees, ea*/ only itea 1. 1. Applicant Name: 2. Naae of MC Insurance Coapany 3. Address of Coapany A. NC Policy Number: YOUR LICENSE CAN NOT BE ISSUREO MITHOUT THIS INFORNATION. LICENSL APPLICATION FOR FOOD, BEVERAGE OR LODGING ESTABLISHMENT OTTER TAIL COUNTY DEPARTMENT PUBLIC HEALTH Division of Environmental Health Courthouse Fergus Falls, Minnesota 218/739-2271 56537 IPrint,type or check all applicable boxes,in-[ I complete and Illegible applications will not be ac-j I cepted and penalties may be assessed.I Old EstablishiaentRenewal ^ New New EstablishmentLicenseeApplication Type: License#Name of previous owner: Applicant Name: If Corporation, name of officers: Le('Sifi?e lAi\ie j?e5o]?TEstablishment name: lAi/e p-e I I A' fiAjy it? < /j IEstablishment location: City/Township 'p'f liCA-Sl Hwy/RoadLake/Stream f-eJ (CA-A/PS /l/)\/pr a.Establishment Mailing Address: Regular:Temporary StandCombination Restaurant # of seats ±Resort # of units Limited Food/Temporary Food Stand Place of Refreshment/Beverage Service # of seats Hotel/Motel # of rooms Boarding/Lodging House # of rooms Total number of employees (See Definition) Does establishment provide Catering?Carryout? X Opening Date: /V /4~ / Closing Date: Business hours Year around Seasonal 1Mater supply source:Municipal Private KPrivateSweage system:Municipal Other facilities if provided:Indoor pool Camping Beach Outdoor pool Boat landing Store Telephone number ( X\ ^ b'^r Minter number if different ( FEE SCHEC SOEFINITIONS HOTEL/NOTEL, BOARDING HOUSE, RESORT, LODGING HOUSf No. of Sleeping Rooas, Units, or,d/or Cabins 1 - 18 19- 35 36- 100 101 and over DUE DATE: All license fees are due prior to January 1 of the year for which application is made or prior to the date of opening for seasonal or new establishment. PENALTY: A. 1 to 7 days late, a 15% penalty. B. 8 to 30 days late, a 25% penalty. C. After 30 days from the due date, the activity for which the licnese is required shall cease. If a new license is approved, the fee shall consist of the amount originally due plus the 25% late penalty fee. RESTAURANT: Place where meals or lunches are prepared for service on premises or elsewhere. HOTEL/NOTEL: Place where sleeping accommodations are offered for one night or more to transients. Fee $ A6.00 $ 90.00 $120.00 $150.00 Lodging fee Penalty____ PLACE OF REFRESHNENT/BEVERAGE No. of Employees 1 - 4 5 - 18 19- 28 29- 35 36 and over Fee $ 42.00 $ 72.00 $108.00 $150.00 $180.00 Penalty Beverage fee RESTAURANT No. of Employees 1 - 4 5 - 18 19- 28 29- 35 36 and over PLACE OF REFRESHNENTS soft drinks or ice cream only, BEVERAGE RESORT :Place where alcoholic beverages or are Feeserved. :Place near recreational area, furn ishing sleeping accommodations for one day, one week or longer and having or more cabins, rooms,, or en closures, :Place where meals or lunches are furnished to five or more regular boarders for periods of one week or more. $ 72.00 $108.00 $150.00 $180.00 Penalty Food fee lOARDING lOUSE LINITED FOOD AND/OR BEVERAGE SERVICE $ 30.00 Fee_____ $ 30.00 Fee Food Fee Beverage Fee :Place where sleeping accommodations are furnished to five or more .OOGING lOUSE Penalty TOTALregular roomers for periods of one week or more. :A11 persons, paid or unpaid, owner lessee, working wife, not licensee's children under 18 years. PNOTICE: The information contained in this applicati«h I becomes part of the county's official record I upon receipt by the agency and is there- 1after accessible to the public. :nployee INITEO FOOD Place that sells only prepackaged food iNO/OR EVERAGE which receives heat treatment and is served in the package (such as Stewart Sandwiches and frozen pizzas, etc.)or mobile units and concession stands serving food and/or alcoholic beverages for 14 days or less in any one location. HAKE CHECK PAYABLE TO: OTTER TAIL COUNTY HEALTH DEPT. ERVICE (Applicant Signature)(Date) 981 Laws Chapter 346 requires that you supply us with information concerning your worker's compensation insurance. If ■ploy anyone, please complete items 1 through 4. If you do not have any paid or otherwise compensated employees, cem^^etC. nly item 1. 1. Applicant Name: 2. Name of HC Insurance Company 3. Address of Company 4. NC Policy Number: YOUR LICENSE CAN NOT BE ISSURED UITHOUT THIS INFORNATION. OHER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH MAIN OFFICE OHER TAIL COUNTY COURT HOUSE FERGUS FALLS. MINNESOTA 56537 Z18-739-2Z71 SUB OFFK 330 WEST M- PERHAM. MINNESC Minnesora Business Ideni: i f icac ion Munber j - g 3 - / 5 7Social Security Number to - S'bDace C-Signature LICENSh APPLICATION FOR FOOD, BEVERAGE OR LODGING ESTABLISHMENT OTTER TAIL COUNTY DEPARTMENT Ui- PUBLIC HEALTH Division of Environmental Health Courthouse Fergus Falls, Minnesota 218/739-2271 56537 r Print,type or check all applicable boxes,in-[ I complete and illegible applications will not be ac-[ I cepted and penalties may be assessed.I -i Old EstablishmentNew EstablishmentNew LicenseeRenewalApplication Type: L'License#Name of previous owner:7 Applicant Name: If Corporation, name of officers: (P'e^noRT JU R i Establishment name: Establishment location: Ci ty/TownshipJ^jhc-Aj^Hwy/RoadLake/Stream (Ht'i R/iiEstablishment Mailing Address: Temporary StandCombinationRegular: Restaurant # of seats S'Resort # of units Limited Food/Temporary Food Stand Place of Refreshment/Beverage Service # of seats Hotel/Motel # of rooms Boarding/Lodging House # of rooms Total number of employees {See Definition) Does establishment provide Catering?Carryout? Opening Date: Af /V^ Closing Date: Business hours Year around Seasonal 7Water supply source:Municipal Private Sweage system:Municipal Private Other facilities if provided:Beach Indoor pool Camping Outdoor pool Boat landing Store Telephone number (X.I ^ S Winter number if different ( ,7 'V FEE SCHEL .SDEFINITIONS HOTEL/NOTEL, BOARDING HOUSE, RESORT, LODGING HOUSf No. of Sleeping Rooms, Units, and/or Cabins DUE DATE: All license fees are due prior to January 1 of the year for which application is made or prior to the date of opening for seasonal or new establishment. PENALTY: A. 1 to 7 days late, a 15% penalty. B. 8 to 30 days late, a 25% penalty. C. After 30 days from the due date, the activity for which the licnese is required shall cease. If a new license is approved, the fee shall consist of the amount originally due plus the 25% late penalty fee. RESTAURANT: Place where meals or lunches are prepared for service on premises or elsewhere. HOTEL/NOTEL: Place where sleeping accommodations are offered for one night or more to transients. Fee $ A6.00 $ 90.00 $120.00 $150.00 1 - 18 19- 35 36- 100 101 and over Lodging fee Penalty____ PLACE OF REFRESHNENT/BEVERAGE No. of Employees 1 - 4 5 - 18 19- 28 29- 35 36 and over Fee $ A2.00 $ 72.00 $108.00 $150.00 $180.00 Penalty 8everage fee RESTAURANT No. of Employees 1 - 4 5 - 18 19- 28 29- 35 36 and over PLACE OF REFRESHNENTS soft drinks or ice cream only, are BEVERAGE RESORT :Place where alcoholic beverages or Feeserved. :Place near recreational area, furn ishing sleeping accommodations for one day, one week or longer and having five or more cabins, rooms,, or en- closures. :Place where meals or lunches are furnished to five or more regular boarders for periods of one week $ 46.00 $ 72.00 $108.00 $150.00 $180.00 Penalty Food fee BOARDING HOUSE LINITED FOOD AND/OR BEVERAGE SERVICE $ 30.00 Fee_____ $ 30.00 Fee Food Fee Beverage Feeor more. ;Place where sleeping accommodations are furnished to five or more regular roomers for periods of one week or more. :All persons, paid or unpaid, owner lessee, working wife, not licensee's children under 18 years. LODGING HOUSE Penalty TOTAL I NOT ICE : The information contained in this app 1 i c at i»r I becomes part of the county's official record I upon receipt by the agency and is there- !after accessible to the public. ENPLOYEE LINITEO FOOD Place that sells only prepackaged food AND/OR BEVERAGE which receives heat treatment and is served in the package (such as Stewart Sandwiches and frozen pizzas, etc.)or mobile units and concession stands serving food and/or alcoholic beverages for 14 days or less in any one location. RAKE CHECK PAYABLE TO: OTTER TAIL COUNTY HEALTH DEPT. SERVICE (Applicant Signature)(Date) 1981 Laws Chapter 346 requires that you supply us with information concerning your worker's compensation insurance. If employ anyone, please complete items 1 through 4. If you do not have any paid or otherwise compensated employees, eeniffttL only item 1. 1. Applicant Name: 2. Name of WC Insurance Company 3. Address of Company 4. VC Policy Number: YOUR LICENSE CAN NOT BE ISSURED MITHOUT THIS INFORNATION. OnER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH MAIN OFFICE OHER TAIL COUNTY COURT HOUSE FERGUS FALLS. MINNESOTA 56537 218-739-2271 SUB OFFICE: 330 WEST MAIN PERHAM. MINNESOTA 56573 November 1984 Dear Applicant, The County ordinances have been revised. Items which affect the applications are as follows. 1. Yearly license renewal applications and fees are due Jan. 1, 1985. Seasonal license renewal applications and fees are due prior to date of opening. 2. The following is the penalty schedule for late applications for renewal 1 icenses. a. 1 to 7 days late, 157„ penalty. b. 8 to 30 days late, 257, penalty. c. After 30 days from the due date, the activity for which a license is required shall cease. If a new license or permit is approved, the fee shall consist of the amount set forth for new licences and permits, plus 257o late penalty fee. 3. The following ordinance section applies to 1986 licenses. "If your water source is private, the water shall be tested for coliform bacteria and nitrate nitrogen every year. Renewal licenses will not be granted until verification and results are submitted to the department. Regular late penalty fees will apply." (Food and Beverage Ordinance, IX. B.) Again, this applies to 1986 licenses. 4. Two new Minnesota Statutes affect applications. The first requires that we ask for your social security number and your Minnesota Business Identification number. Please include these numbers on the sheet provided and return it with your application. The second new statute requires a choking poster to be posted in all food service facilities. Please post the enclosed poster in an area easily seen by employees. Copies of the new county ordinance may be picked up at this office or will be distributed during the yearly inspections. Contact this office if you have any questions. Sincerely, Brenda L. Barber, R.S. Director of Environmental Health BB/sw OTTER TAIL COUNTY DEPARTMENT OF PUBLIC HEALTH MAIN OFFICE OHER TAIL COUNTY COURT HOUSE FERGUS FALLS. MINNESOTA 56537 218-739-2271 SUB OFFICE: 330 WEST MAIN PERHAM. MINNESOTA 56573 Minnesota Business Identification Number Social Security Number Date Signature // OTTER TAIL COUNTY DEPARTMENT PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH COURT HOUSE FERGUS FALLS, MINNESOTA 56537 218/739-2271 LICENSE APPLICATION FOR FOOD, BEVERAGE OR LODGING ESTABLISHMENT Print, type or check all applicable boxes. Incomplete applications will not be accepted and penalties may be assessed. ____New Licensee: ____New Establishment ____Old Establishment;Application Type;____Renewal For Office Use Only: Type of License SL21-HEHR n Limited Food mi County Fair OCombinationO Regular Estab If cbStrg per Name of Previous Owner License Number $ed Date of Opening la/iXi^ I IT nEfm 1111Applicant Name; Last 1st First and Middle mid1st \im\a i i i i i iatt Establishment Name: If Corporation, Name of Officers Establishment Location:City/Township If on Lake, name of Lake i^/T i^j;^ I For Office Use Only Establishment Address; mcdcocstr i/’iJi I I 11 ...MidCity:Zip Code \ BH I cit zipsta A I RS IBusiness Type:REGULAR PRRestaurant Place of Refreshment Boarding House lim Irt IHotel/MotelHM Resort LH Lodging House LIMITED FOOD Food Beverage Food and Beverage Ifb II BV 1FoodCOUNTY FAIR Beverage Food and Beverage COMBINATION Hotel/LmtdFd Motel/Lmtd Fd Lodging/Lmtd Fd Place of Refreshment/Lmtd FdResort/Lmtd Fd For Office-Use OnlyB's^easonal LUOY=Year Round Does Establishment Provide: CH 1 = Food Catering dl 2=Carryout ufl 7 8 11 uf2 Water Supply Source;_____ Municipal Sewage System:____Municipal uf3 1 3 4 Swimming Facilities Provided:____None ____Beach ____Indoor Pool ____Outdoor Pooluf38 Telephone Number: Area Code: uf4 uf5 For Office Use Only: Variable I I i 1 I I Penalty adf pen Ck#Int CashAmt NELSON BROS. PRINTING. INC., Fergus Falls. MN 5653?OTC DPH (6/83)SEE REVERSE SIDE FOR DEFINITIONS AND FEE SCHEDULE DEFINITIONS LwOGING FEE SCHEDULE $10.00 PENALTY FEE for each license category is required when applying after January 31st for each year-round es tablishment or 30 days after opening for seasonal or new establishments. No. of Sleeping Rooms, Units, and/or Cabins 1- 18 19- 35 36- 100 101 — and over Fee $ 46.00 $ 90.00 $120.00 $150.00 Lodging Fee PenaltyNEW BUSINESS OR NEW OWNERS opening after October 1st and before January 1st, are required only to pay one half (Vz) of the normal annual fee.BEVERAGE SERVICE FEE SCHEDULE LODGING/FOOD/BEVERAGE: If you operate a hotel, motel, or resort, only one additional license fee is necessary for all food and/or beverage facilities on the same premises. That license fee to be based on average number of employees of all food and/or beverage facilities. No. of Employees Fee 1- 4 5- 18 19- 28 29- 35 36— and over $ 42.00 $ 72.00 $108.00 $150.00 $180.00 Beverage Fee PenaltyPlace where meals or lunches are prepared for service on premises or elsewhere. Place where sleeping accommoda tions are offered for one night or more to transients. Place where alcoholic beverages or soft drinks or ice cream only, are served. Place near recreational area, furn ishing sleeping accommodations for one day, one week or longer and having five or more cabins, rooms, or enclosures. Place where meals or lunches are furnished to five or more regular boarders for periods of one week or more. Place where sleeping accommoda tions are furnished to five or more ■ regular roomers for periods of one week or more. All persons, paid or unpaid, owner lessee, working wife; not licensee's children under 18 years. Place that sells only prepackaged food which receives heat treatment and is served in the package (such as Stewart Sandwiches and frozen pizzas, etc.) or mobile units and concession stands serving food and/or alcoholic beverages for 14 days or less in any one location. RESTAURANT FOOD SERVICE FEE SCHEDULE HOTEL/MOTEL No. of Employees Fee $ 42.00 $ 72.00 $108.00 $150.00 $180.00 1- 4 5- 18 19- 28 29- 35 36— and over PLACE OF REFRESH MENT/BEVERAGE Food Fee PenaltyRESORT LIMITED FOOD AND/OR BEVERAGE ' SERVICE FEE SCHEDULE $30.00 $30.00 Food Fee Beverage Fee Fee BOARDING HOUSE Fee Penalty TOTAL LODGING HOUSE NOTICE: The information contained in this application becomes part of the county's official records upon receipt by the agency and is thereafter accessible to the public. ~~ EMPLOYEE MAKE CHECK PAYABLE TO: OTTER TAIL COUNTY LIMITED FOOD AND/ OR BEVERAGE SERVICE Applicant's Signature Date 1981 Laws Chapter 346 requires that you supply us with information concerning your worker's compensation insurance. If you employ anyone, please complete items 1. through 4. If you do not haye any paid or otherwise compensated employees, complete only item 1. 1. Applicant Name: 2. Name of WC Insurance Company: 3. Address of Company: 4. WC Policy Number: YOUR LICENSE CAN NOT BE ISSUED WITHOUT THIS INFORMATION. LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURTHOUSE, FERGUS FALLS, MN 56537 218-739-2271 July 25, 1997 Jane Kunkel Leisure Lane Resort RR#2 Box 120 Pelican Rapids, MN 56572 RE: Resort Campsites, Prairie Lake (56-915). Dear Ms. Kunkel, As we have discussed, in order for the "grandfather clause” to apply, the nonconforming use must have been established prior to the original effective date (October 15, 1971) of our Shoreland Management Ordinance (SMO) and must have been continuous since that date. Although the letters (Petry and Maskey) you provided on July 17, 1997 support your assertion that there were Recreational Camping Units (RCU) onsite prior to the enactment of our SMO, the records form our Department of Health indicate that RCU's have been onsite on an intermittent rather than a continuous basis since October 1 5, 1971. Since this is the case, the "grandfather clause" can not be applied to your situation which means that your resort must limited to the five (5) rental cabins currently authorized. If you have any further questions regarding this matter, please contact our office. Sincerely, Bill Kalar Administrator cc: Mark Ronning, Otter Tail County Health Dept. mis J3eisure JQanQ ^esod Rt 2 - Box 120 Pelican Rapids MN 56572 218-863-4490 or 1-800-358-1883 (e-mail llr@prtel.com)^BCEivs) ^ ^ 1997 ^o&fl£soufice July 17, 1997 Bill Kalar Land & Resource Management Otter Tail County Courthouse Fergus Falls MN 56537 Dear Bill: Enclosed please find two statements verifying there were campers on the resort prior to 1971, therefore, allowing campers should be grandfathered in. Please review these statements and contact me if you have any fiirther questions. Based on these statements we are assuming that we are allowed two campers due to the grandfather clause. Thank you for your attention to this matter. ane Kunkel Enclosures TO WHOM IT MAY CONCERN: I, Fem Petry, make this statement as the owner of Leisure Lane Resort during the time prior to October 15, 1971. I have made a diligent search for the permit we had posted allowing us two campers at the resort at that time and for several years prior to that time, but have been unable to find it. Under the authority of this permit, we allowed self-contained campers or if they only slept in their camper and stayed with a relative who rented a cabin from us. This permit was issued to us by the state. Dated this ^0 day of June, 1997. Fern Petry 1502 N 61 Street Omaha NE 68104 (402) 551-3032 TO WHOM IT MAY CONCERN: I, Lloyd Mackey, make this statement as a neighbor and prior worker of Leisure Lane Resort during the time prior to October 15, 1971. For as long back as 1965 I can verify that campers were allowed on the resort. These campers were allowed under a permit issued by the state to the previous owners. I assert that this permit was posted in the office and I had seen it several times. Dated this day of June, 1997. o Lloyd Mackey Pelican Rapids MN 56572 (218)863-2289 <k Department of •V LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAIL Phone:(218) 739-2271 Court House FERGUS FALLS, MINNESOTA 56537 August 7, 1996[ i -IArlie Schultz ! 6645 86th SE Mantador, ND 58058i 1. RV, Prairie Lake (56-915)RE:i Dear Mr. Schultz: :As per our phpne conversation you agreed to remove your RV that is located on Lot 3 Subrosa Beach, Prairie Lake (56t915) before September 1, 1996. The property is owned by Daniel Kracht. In order to place anyc structure on a lot in the Shoreland Area, you must apply for and receive a Permit to do so. i- If you remove! the RV prior to September 1, 1996 no further action will be ,, necessary. i Thank you for > your cooperation in this matter, if you have any. questions, please contact ;Our office. rSincerely, Wayne Roisum Inspector ! !mgb i i ! i 1 OTTER TAIL COUNTY LAND AND RESOURCE MANAGEMENT County Courthouse, Fergus Falls, MN 56537 218-739-2271 Ext. 225 July 25, 1996 Dan Kracht R#2 Box Pelican Rapids, MN 56572 RE: Recreational Vehicle on Lot on Prairie Lake (56-915) Dear Mr. Kracht: Our office received a complaint regarding a Recreational Vehicle (RV) located on your property. On July 17,1996, I visited your property in order to investigate this matter. At that time, I found a RV onsite. This RV appeared to be located on or too close to the sewer. When I returned to the office I could not find any permits allowing this structure to be placed onsite. Please contact me before August 1 5, 1996 to discuss this situation. A n /jVSincerely, Wayne Roisum Inspector mgb a ^ jjli^ \p FIELD IMVESTIGATIOM REPORT / - NATURE OF VIOLATION;HEASUREMENTSi A. Grade/Fill Project ___ B. Building Project A. Setback Dlstancee Lake/River Ft Sevage DisposalC.Road Right-Of-Way Ft i •.LotrinM'D. Other (Describe)Ft &Ft ? • , Eleva'tloiLi •E.None ,___ Ft Photographs;B. Size Bldg/Area __ Ft XNumber Taken Ft =Sq Ft ! : - Max.L V,FtDepth ^/Cutinn -6 o /J . V9. Pt) ^ <0^ Max. Depth of Fill Ft * \ f / ' .*• -SKETCH: I D'‘~j_Ph‘\ ; >■VI ■()0V v> * •V* •• »r {■ 0 ,0 "a S ’ f[/ fA.^ 0 ^ \ ' 4 OBSERVATION/RECOHHENDATION; ^ ^ "ho j/( ^ / fjLA.----^ llh/}~%cINV^TIO^TE'd BY:_L DATE:TINE: