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Home My WebLink AboutMadsen's Resort Inc._25000990565000_Shoreland Permits_LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMITWHITE - Office . . GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Asfessor Permit No.PLEASE PRINT OR TYPE ALL INFORMATION TWP NAMERANGETWP NO.SECTIONLAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. R.^ ol I 09/j I €jj&T2>5L~2H0 I ^^la(vc-v\-E~ PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) LEG7M?15eSCRIPTION ^ or- a __XUnZ £ix(0 y yy gM LK % Daytime Phone No.Initial Mailing AddressFirstLast Name ^ TTt f^-cif /tA. Property Owner ■5Z<^S' Contractor Name Lie.# ONSITE SEWAGE TREATMENT SYSTEM PROPOSED PROJECT (please circle the appy^priate number) ^^^p\dd’n to Dwellip^" ( 5 ) RCU/Year___I ( 7 ) Add’n To Non-Dwelling ( 8 ) Storage Structure (10) Other. ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure setback to a well. TXfleplacement Dwelling 6j/Betached Garage ( 9 ) W.O.A.S. ( 1 ) New Dwelling ( 4 ) MHA'R_____ ( ) Permit No. ItJJFCSD * This permit is ortly valid alter verification from the O.T.LS.D. that a conforming sewage system wiil be installed to service this lot contact Rollie Mann at 864-5533.'Existing Dwelling to be removed before. CHARACTMISTICS OF PROPOSED NON-DWELLINGCHARACTERISTICS OF PROPOSED DWELLING ChfARACTERISTICS OF PROPOSED W.O.A.S. (WATEB ORIENTED ACCESSORY STRUCTURE)Outside cIj. I I Vv—- Dimension Ft. x / ' "f~ Setback to Lotline 0~^ ^ ^ Ft." Setback to Right of Way R " -j- Setback to Ordinary High Water Level Ft. Elevation Above Ordinary High Water Level ^ Ft. Setback to Septic Tank Ft. ' ^ “t Ft. Outside \ Dimension \ Setback to Lotline \ Setback to Right of War Setback to Ordinary High\Water Level __ Elevation Above Ordinary hVi Water Level Setback to Septic Tank___ Setback to Drainfield____ Setback to Bluff________ Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No Ft. X Ft."Outside N. Dimension \ Setback to Lotline _^ Setback to Right of Way Setback to Ordinary High W^ter Level __ Elevation Above Ordinary High W|ter Level Setback to Septic Tank Setback to Drainfield _ Setback to Bluff_____ Ft,"Ft.&Ft."Ft. X Ft."Ft,&Ft," Ft.FI." Ft.Ft. Ft.Ft.Setback to Drainfield Setback to Bluff F*-it.■t. ~>o(x^No Maximum Proposed Height Basement______ Walkout Basement Ft.Ft. Yes Ft.Lt- NoYes Ft.Maximum Proposed Height ( ) Boathouse ( ) Screen Porch ( ) Storage Structure Total Bedrooms r n ii(5ft>* /_____________yj T **Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Appiication / inspection ' Must include on scale drawing Permit may be required Topographical Alteration / Earthmovina ^None □ 20 Cubic Yards or Less * □ 21 Cubic Yards - 299 Cubic Yards* ISaRACTERISTICS^OT: □ 300 Cubic Yards or More' ^SlfTT— Water Frontage Ft.BluffLot Area. 1.Impervious Surface Ratio:.%xioo =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. 1 understand that it is my responsibility to inform the Land & Rp^urce Management office once the building footings have been constructed. Signatured Property Owner ^ (6^^ pDate: 10-3-02-Date: Lan6 & Rei PERMIT FEE $RECEIPT NO. Comments: Form No. BK — 0500-0501 306,638 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota 't > LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218)739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMITWHITf^ - Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor q: i IPermit No.PLEASE PRINT OR TYPE ALL INFORMATION I TWP NAMERANGETWP NO.SECTIONLAKE/RIVER CLASSLAKE/RIVER NAMELAKE / RIVER NO. IolI I5L-2H0I ftLAivc>vE~ PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) 3 lecwlCescription ^ ~ or AnrirrT A 2.<7> ^ I7/LJ2 12^ £(x<0 Y ^c) LK .3 3ZJ^4clc<5 ■i 1 j'i Daytime Phone No.Mailing AddressInitialFirstLast Name y~]iS2^ sr^ f^TTCF . =*■Property Owner Ftttr AA i 3Contractor Name Lie.# t PROPOSED PROJECT (please circle the appttSpriate number) /(^^dd'n to Dwellipgy^ ' ('3')-;Replacement Dwelling ( 5 ) RCUA'ear I 6 IDetached Garage (9) W.O.A.S. ONSITE SEWAGE TREATMENT SYSTEM ONSITE WATER SUPPLY Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a weli. (1 ) New Dwelling (4 ) MHA-R____ (7 ) Add’n To Non-Dwelling (8 ) Storage Structure (10) Other ( ) Permit No. IJJDTLSD * This permit is ortly valid after verification from the O.T.L.S.D. that a conforming sewage system mil be installed to service this iol contact Roilie Mann at 864-5533.’Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED NON-DWELLINGCHARACTERISTICS OF PROPOSED DWELLING CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)Outside Dimension Setback to Lotline V X Ft. & Outside Dimension Setback to Lotline Setback to Right of Way '2^ Ft." I >Ft."Ft. X_ Ft. X _r Outside Dimension Setback to Lotline \ Setback to Right of Way Setback to Ordinary High W^r Level __ Elevation Above Ordinary High W(ater Level Setback to Septic Tank Setback to Drainfield _ Setback to Bluff_____ Ft."Ft.&Ft."Ft."Ft. X\Ft.”Ft."Setback to Right of Wa Setback to Ordinary HighWater Level __ Elevation Above Ordinary High Water Level Ft.& \Ft.Setback to Ordinary High Water Level Elevation Above Ordinary High Water Level ^ Setback to Septic Tank Ft. Setback to Drainfield ' Ft. Setback to Bluff Ft. :■Ft.Ft.”f' Ft. Ft.Ft. iSetback to Septic Tank___ Setback to Drainfield____ Setback to Bluff________ Maximum Proposed Height Bathroom Proposed ( ) Yes ( ) No Ft.Ft.1 ft.■t. 1Ft.Maximum Proposed Height Basement______ Walkout Basement Total Bedrooms Ft.Ft.1 iYesFI.■t..iIFt.Maximum Proposed Height ( ) Boathouse ( ) Gazebo ( ) Screen Porch ( ) Storage StructureI f()■IPrbject/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection /i* Must include on scale drawing Permit may be required Topographical Alteration / Earthmovlnq □ None □ 20 Cubic Yards or Less * □ 21 Cubic Yards ■ 299 Cubic Yards*□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: "7 i.sq:Ttr“Bluff.Ft.Water FrontageLot Area__^ TImpervious Surface Ratio:xioo =.%■iImpenmius Surface RatioTotal Lot Area (FT^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 responsibiiity to inform the Land & Resource Management office once the building footings have been constructed. ■ ’ T U ■ -7>/6-&Date: Date:/ Land & Resource Man'1S‘^ RECEIPT NO.PERMIT FEE $ Comments: Form No. BK — 0500-0501 308,638 • Victor Lundeen Co.. Printers • Fergus Fails. Minnesota r SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Ft.Structure Set Back from Ordinary High Water Level Ft.3’CkO t— Ft.Ft.Structure Set Back from Top of Bluff Ft.Structure Set Back from Road Right of Way Ft. T- Ft. &Ft.Ft.&Structure Set Back from Lot Lines Ft. (3 / (o Ft.Ft.Structure Height Ft.Structure Set Back from Septic Tank Ft.(0^ Ft.Ft.Structure Set Back from Drainfield / Elevation Of Lowest Floor Above Ordinary High Water Level Ft.Ft. Land Slope at Building Site %% Inspector’s Comments / Sketch: Mr/'s sro^^t rL Inspector's SigMTure Urc Date of Inspection Time of Inspection a Project Approved Date/Initial SLAtJ^hl£^LAfC. K^SOIZr \" >=■ 9C>’Pg£S 9‘»> EMIL MADSEN - ARCHITECT ROUTE 3, BOX 3^5 • BATTLE LAKE, MINNEBOTA 96S 1 9 RHONE (2 1 a) B6A>9AOO V LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLiCATIOM FOR SITE PERMITWHITE ■ Office GOLDENROD - Inspector YELLOW - Owner PINK ■ Assessor Permit No.LEGAL DESCRIPTION BLUFF ZONEAND □ YES [S NO LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS SECTION TWP NO.RANGE TWP NAME I 4o PARCEL NUMBER (S)TOPOGRAPHICAL ALTERATION □ YES # OF CUBIC YARDS FIRE NUMBER Ss~) IDENTIFICATION: Please Print All Information NO TELEPHONE NO. First Mailing Address — No. Street, City, State, and Zip CodeLast Name Initial (Daytime) fr ?- '&cJr 32T_________Property Owner tiy\ NameContractor State Lie. # ONSITE SEWAGE TREATMENT SYSTEM ( ) Individual Permit #_____ ( ) Collector Permit #_____ JM OTLSD PROPOSED PROJECT ( ) New Structure(s) ^ Addition(s) ( )MH/RV____________ PROPOSED USE ONSITE WATER SUPPLY (fO Individual ( ) Public ( )None ^ Dwelling ( ) Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS)YEAR CHARACTERISTICS OF WOASCHARACTERISTICS OF NON-DWELLING ( ) Garage ( ) Utility Structure CHARACTERISTICS OF DWELLING ( ) Screen Porch( ) Boathouse( ) Dwelling ^ Addition to Dwelling ( ) Basement ( ) Walkout Basement JCj Ft.x ( ) Utility Structure( ) Gazebo( ) Other Outside Dimension ( ) Other, Outside Dimension .Ft..Ft.x Outside Dimension .Ft. .Ft.Lotline Setbacks Ft.&.Ft.Ft.x .'To R.Lotline Setbacks Ft.&.Ft.OHWL Setback Ft.Lotline Setbacks & /oo .Ft.OHWL Setback ( )No (If Yes / a complying Sewage System Required) Bathroom: .Ft.OHWL Setback} _Total Bedrooms g/^TsO Ft?^story^ Maximum Height /10 ft. (1 story)Maximum Height / 18 Ft. (1 story)Maximum Hei r) %,Sq. Ft. Impervious Surface RatioSq. Ft. Impervious SurfaceLot Area M 3 Ft. (3’minimum).Ft. Elevation of lowest floor above OHWLWater Frontage .%Ft. Slope of lotStructure setback to right-of-way ID Ft. (10'minimum) (Sewage System Permit required before installation). Ft. (20’minimum) (Sewage System Permit required before installation). Ft. (10'minimum) (Sewage System Permit required before installation). Structure setback to septic tank AODwelling setback to Soil Absorption System__ Non dwelling setback to Soil Absorption System yM-T 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 Ordinance 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 &lurce Management office once the building footings have been constructed. Dated: ure oTOwnerSigr^/i Dated: Land & Resource Management OfficeS(f /.25-//yRECEIPT NO.PERMIT FEE $ cL a ^ip/voiNLt d OrL Comments: /) D ZiYTfl'omd: mi <rO Form No. BK — 0496-002 Cl (LCf6!^hr)nj.AU^Co.. Printers • Fergus Falls, MN • 1-800-3A6-4870 LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT H^SE___Phone:(218)739-2271 • FERGUS FALLEN £6537\ I APPLICATION FOR SITE PERMITIVHJTE - O GOLDENROD - Inspector YELLOW ■ Owner PINK - Assessor ■ 1r i 1/r/3 //Permit No.I LEGAL DESCRIPTION ' AND ' LOCATION 6-1ff.BLUFF ZONE □ YES (3 NO RANGE TWP NAMELAKE/RIVER CLASS TWP NO.LAKE NUMBER LAKE/RIVER NAME : 4a^ f Ir /<i) 1 33;r:tA 0 ur i TOPOGRAPHICAL ALTERATION □ YES # OF CUBIC YARDS NO FIRE NUMBER- PARCEL NUMBER (S) eJs I TELEPHONE NO.ipENTIFICATION: Please Print All Information j. Mailing Address — No. Street, City, State, and Zip Code (Daytime)First InitialLast Name pr ? '&cr 3?.q RATU.C / arClS~ t Property Owner /VlA/>Vt^»tA VrC\L \A/\ /I/l AO CTRL' S _______ 2ltkzh3S^J IiiName• iContractor State Lie. #-j I ONSITE SEWAGE TREATMENT SYSTEM ( ) Individual Permit #_____ ( ) Collector Permit #______ ^ OTLSD ONSITE WATER SUPPLY Individual ( ) Public ( ) None PROPOSED USE j)s) Dwelling ( ) Non-Dwelling ( ) Water Oriented Accessory Structure (WOAS) PROPOSED PROJECT ( ) New Structure(s) Addition(s) tf ( ) MH/RV______________ 1 I1 .1 1 r YEARr CHARACTERISTICS OF WOASCHARACTERISTICS OF NON-DWELLING ( ) Garage ( ) Utility Structure CHARACTERISTICS OF DWELLING ( ) Dwelling ^ Addition to Dwelling ( ) Basement ( ) Walkout Basement Outside Dimension ( ) Screen Porch( ) Boathouse i ( ) Utility Structure( ) Gazebo( ) Other Outside Dimension \ r Vi:^±izjFir..-.iL f( ) Other___ Outside Dimension__ -3^ 2o .Ft..Ft..Fix Lotline Setbacks .Ft..Ft.x Jh Ft.& Ft. /nn Lotline Setbacks Ft.OHWL Setback t.&.Ft.Lotline Setbacks .Ft.OHWL Setback Bathroom: A )Yes ( ) No (If Yes / a complying Sewage System Required).Ft.OHWL Setback1Total Bedrooms FtT^^^stor^Maximum Height /10 ft. (1 story)Maximum Height /18 Ft. (1 story)Maximum Hei .369____ Sq. Ft. Impervious Surface RatioSq. Ft. Impervious SurfaceLot Area :2..Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage Ala %____________Ft. Slope of lot .Ft. (10'minimum) (Sewage System Permit required before installation). .Ft. (20'minimum) (Sewage System Permit required before installation). .Ft. (10’minimum) (Sewage System Permit required before installation). Structure setback to right-of-way. laStructure setback to septic tank jSaDwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System m$ IS A SITE PESMIT 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. .Y . mm ^Signore 6f‘^wner ' ' ^ , /Dated:7417 r ■ iL.>-')3-\Dated;Land & Resource Marl^gem^it-O^ic^^^A RECEIPT NO. / / 7 ' 2OO 50PERMIT FEE $3LY- ~T-6^ 4 j a- A 7 r / a i/Comments: 3^1•>/ L49-'7-Y'-t.//T/ T /a/'' Form No. BK — 0496-002 2B1.017 • Victor Lundevn Co. Priniort • Forgus Falls. MN • 1-800-346-4870 INSPECTION RESULTS Make all measurements and computations 100^"Ft.Structure Set Back from Ordinary High Water Level Ft. Ft.Ft.Structure set Back from Top of Bluff Ft.Ft.Structure Set Back from Road Right of Way Ft.& ^0^ Ft.Ft.,Ft.&Structure set Back from Lot Lines Ft.Ft.Structure Height I o'Ft.Ft.Structure Set Back from Septic Tank Ft.Ft.Structure Set Back from Absorption System Elevation Of Lowest Floor Above Ordinary High Water Level____________________Ft.Ft. %%Land Slope at Building Line Inspector's Comments / Sketch: o<j/\^ ov\^, It ^ J*- * • /o •7 lb I yr- r& r.- JM/Inspector's Signature Date of Inspecfie/ffi .•'-T Lei 'r - Time^ Inspection •vM ... EMIL MADSEN - ARCHITECT ROUTE 2, BOX 3AS • BATTLE LAKE, MINNESOTA S6515 PHONE (2 1 B) BfiA-SAOO BLAa/^^£'LAKE , R'e-SOZT ‘S.saLb-'. ;"=5i?'pe«; LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMITWHITE - Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor 12^1 LIfy\A'OierY'$Permit No.LEGAL DESCRIPTION AND LOCATION SECTION TWP NO.RANGELAKE/RIVER NAME LAKE/RIVER CLASS TWP NAMELAKE NUMBER \33 /^ve:tz.TSI FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER (S) 0066^00 -ff- ^5^4V -6 - 5 / IDENTIFICATION; Please Print All Information Mailing Address — No. Street, City and State Zip Code Telephone No.Last Name First Initial flT.3^ Be A 33^Pi Pi £5Property Owner igpcrTic l jv NameContractor State Lie. # PROPOSED PROJECT PROPOSED USE ( l^'jT'^esidential ( ) Non-Residentlal RESIDENTIAL USE \yP^r\e Family Dwelling ( ) Multiple Dwelling # of Units ( ) NON-RESIDENTIAL USE ( ) Garage ( ) Utility Structure ( ) Water Orientated Accessory Structure ( ) Other CHARACTERISTICS OF PROPOSED ( ) New Structure ( i,.-)^ddition ( ) MH/RV (Basement ( Walkout Basement ( ) Outside Dimension r I y * of Structure______^ i Ft.YEAR Ft.TYPE OF FRAME ( ) Masonry { L-f^od ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY Height of Structure. # Of Stories /{ ) Public ( i.''''fTndividual ( ) None OFFICE USE ONLY ) Bluff Impact Zone ) Shore Impact Zone ) Sensitive Area ( ) Public ( ) Individual Permit #_( U'^TLSD (ft Of Bedrooms r/A(# Of Bathrooms ( LOT SIZE AND SETBACKS: 30 9Lot Area is square feet. Water frontage is feet. Maximum depth of lot feet. /ooBuilding set back from ordinary high water level is feet. (String Test) ■^2 feet. Slope of lotLand height above ordinary high water level at building line is % Building set back from road right-of-way .feet. 3o ^50Lot line setback is feet.and Structure will be located feet from septic tank (Sewage System Permit must be obtained before installation). Structure will be located.feet from soil absorption system (Sewage System Permit must be obtained before installation). 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. Dated: Signature of Owner I Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. /5.Id - J2 13Dated; Land & Resource Management Office Permit Fee S // a /Receipt No_ U /O - 7-f3Comments: Form No. BK — 0292>002 262,316 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota tT APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 IVH/TE - Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor /.3V4 7Permit No.LEGAL DESCRIPTION AND LOCATION RANGE TWP NAMESECTIONTWP NO.LAKE/RIVER NAME LAKE/RIVER CLASSLAKE NUMBER ^Z>I91 FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER (S) 006ff-6-5-1- 600TITA IDENTIFICATION; Please Print All Information Zip Code Telephone No.Mailing Address — No. Street, City and StateFirst InitialLast Name fix A &>)( SJ'IProperty Owner ZAi(/<r /Tf NameContractor State Lie. # PROPOSED USE RESIDENTIAL USE NON-RESIDENTIAL USE ( ) Garage ( ) Utility Structure ( ) Water Orientated Accessory Structure ( ) Other CHARACTERISTICS OF PROPOSEDPROPOSED PROJECT Basement ( ) fji''- ' Walkout Basement ( Outside Dimension /- I y of Structure o Ft. ( XX'S One Family Dwelling ( ) Multiple Dwelling # of Units ( ) ( U-fResidential ( ) Non-Residential ( ) New Structure ( i^-^-Addition ( ) MH/RV / YEAR Ft.TYPE OF FRAME ( ) Masonry ( i,.-^ood ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY ( ) Public ( p'-'flndividual ( ) None Height of Structure. # Of Stories /OFFICE USE ONLY ) Bluff Impact Zone ) Shore Impact Zone ) Sensitive Area ( ) Public ( ) Individual Permit #_( u..<6tlsd (# Of Bedrooms ff'h(# Of Bathrooms ( LOT SIZE AND SETBACKS: Lot Area is square feet. Water frontage is feet. Maximum depth of lot feet. moBuilding set back from ordinary high water level is feet. (String Test) FkirlL'i rLKfT3feet. Slope of lotLand height above ordinary high water level at building line is % 3aBuilding set back from road right-of-way feet. 3o ^Lot line setback is feet.and toStructure will be located feet from septic tank (Sewage System Permit must be obtained before installation). 3aStructure will be located.feet from soil absorption system (Sewage System Permit must be obtained before installation). 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. X cA J.4. X//0 J —»■.___Dated: Signature of Owner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. /6 7^.^^l.iDated: Land & Resource Managermnt Office H nfj5o. £>nPermit Fee $.Receipt No„ : 3 /om-f3Comments: Form No. BK — 0292-002 262,316 — Victor Lundean Co., Printers. Fergus Falls, Minnesota r"'INSPECTION RESULTS Make all measurements and computations ACTUAL MINIMUM Sq. Ft. Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft.Ft. tBuilding Set Back from High Water Level Ft.IfS Ft. HoBuilding Set Back from Top of Bluff Ft.30 Ft. I300- Voc) ■ FtBuilding Set Back from Road Right of Way 20 Ft. wI^‘P_Ft. &Building Set Back from Lot Line Set Back Ft.Ft. Building Height Ft.Ft. -f-Building Set Back from Septic Tank Ft.10 Ftf o Building Set Back from Absorption System Ft.20 Ft Elevation Above High Water Level at Building Line f♦ Ft.3 Ft. okLand Slope at Building Line % » . Inspector's Comments:__I * ,Sketch: ■ •>' Inspector 's Signature I »v> 10- B-'t3 Date of Inspection 3.30 Time of Inspection■lit 1 SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone; (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMIT WHITE —Suffice GOLDENROD — Inspector YELLOW — Owner PINK — Assessor LEGAL Permit No. DESCRIPTION AND LOCATION SECTIONLAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS pO TWP RANGE TWP NAME 6ue>^-b>133 FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER (S) IDENTIFICATION: Please Print All Information First Mailing Address — No. Street, City and SlateLast Name____________________ . ......MrjiliHsfrOTKi C-Kafl-gS Initial Zip Code Telephone No. IjatLle UIXa. \ Mh! SkSTS Property Owner £NameContractor 3State Lie. It CHARACTERIST^OF PROPOSEDPROPOSED PROJECT PROPOSED USE RESIDENTIAL USE NON-RESIDENTIAL USE ( ) Garage ( Structure ( ) Water Orientated Accessory Structure New Structure ( ) Addition ( ) Other ( ) Residential ( ,»-)H^on-Residential )'One Family Dwelling ) M^ple Dwelling # of Um<s { ) Basement ( Walkout ------------------------T' Outside Dimension of Structure______ {( ( Ft. IS FtTYPE OF FRAME j ( ) Masonry ( c-,)Hf^od ( ) Structural Steel { ) Other ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY { ) Public ( ) None ( ) Other Height of Structure it Of Stories/OFFICE USE ONLY { AJ) Bluff Impact Zone {iry/ ) Shore Impact Zone { ) Sensitive Area ( ) Public ( ) Individual it Of Bedrooms # Of BathroomsPenpit It ( LOT SIZE AND SETBACKS:J(22 feet. Maximum depth of lot feet.Lot Area is square feet. Water frontagers iM feet. (String Test)Building set back from ordinary high water level is feet. Slope of lotLand height above ordinary high water level at building line is % xoBuilding set back from road right-of-way.feet. inin feet.Lot line setback is and m feet from septic tank (Sewage System Permit must be obtained before installation).Structure will be located feet from soil absorption system (Sewage System Permit must be obtained before installation).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. Dated: Signature of Owner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated: Land & Resource Management Office Permit Fee $.Receipt No., Is/XnJfjj fWfc OhjiuS Comments: Form No. BK — 0292-002 262,356 — Victor Lundeen Co., Printers. Fergus Falls. Minnesota SHORELAND MANAGEMENT — COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMIT WHITE - Office GOLDEHROD — Inspector YELLOW — Owner PINK — Assessor IlSl^Permit No.LEGAL DESCRIPTION AND LOCATION SECTION TWP RANGE TWP NAMELAKE NUMBER LAKE/RIVER NAME LAKE/RIVER L(0 (ilcMltAt--eup.Ts FIRE OR LAKE ASSOCIATION NUMBERPARCEL NUMBER (S) &5 I IDENTIFICATION: Please Print All Information First Mailing Address — No. Street, City and State Zip Code Telephone No.Last Name Initial HftiNSfrOKi CKaH-gS Ua z-_____fjr-L T>TJf__________ LyiU/j i/J iusr:! Property Owner Qr'-.Si-NameContractor State Lie. # CHARACTERISTICS OF PROPOSEDNON-RESIDENTIAL USE ( ) Garage ( j^^^)^Jlility Structure ( ) Water Orientated Accessory Structure ( ) Other RESIDENTIAL USEPROPOSED PROJECT PROPOSED USE )'One Family Dwelling ) Mi)Hiple Dwelling Basement ( f / ) Walkout Basement^—'T^ Outside Dimension of Structure______ ( ■ ) New Structure ( ) Addition ( ) Other ( ) Residential ( w--)'Nbn-Residential ( ( ___Ft. IS- Ft. \3(0 If of Units () ONSITE WATER SUPPLYTYPE OF FRAME ( ) Masonry ( ,_ )Wood ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM!Height of Structure # Of Stories /( ) Public ( (_>1rtdividual { ) None / OFFICE USE ONLY ( ^ /) Bluff Impact Zone (k/ ) Shore Impact Zone ) Sensitive Area JS'( ) Public ( ) Individual Permit #_ ( V-^OnSD # Of Bedrooms # Of Bathrooms ul LOT SIZE AND SETBACKS: feet.square feet. Water frontage is feet. Maximum depth of lotLot Area is r'feet. (String Test)Building set back from ordinary high water level Is feet. Slope of lot %Land height above ordinary high water level at building line is XO feet.Building set back from road right-of-way. laja feet.Lot line setback is and m feet from septic tank (Sewage System Permit must be obtained before installation).Structure will be located feet from soil absorption system (Sewage System Permit must be obtained before installation).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 BUILDIf^ PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES.' '■ // Signature ol Owner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit Is granted upon the express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinance of Otter Tall County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated: A IDated: Land & Resource Management Office Permit Fee $.Receipt No. Comments: Q-lauj rHS Form No. BK — 0292-002 262,358 — Victor Lundeen Co.. Printers, Fergus Falls. Minnesota r : r,'»’ yjfv r.v ‘ <] INSPECTION RESULTS Make all measurements and computations id ACTUAL MINIMUM Sq. Ft. Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft. Ft. ;oo~fBuilding Set Back from High Water Level Ft.Ft. Building Set Back from Top of Bluff Ft.30 Ft. (ooA'Building Set Back from Road Right of Way Ft.20 Ft. 10 +-ii^^Ft. &Building Set Back from Lot Line Set Back Ft.Ft. Ft.Building Height Ft. Building Set Back from Septic Tank 10 FtFt. Building Set Back from Absorption System Elevation AboveHigh Water Level at Building Line 20 FtFt. 3 Ft.Ft. Land Slope at Building Line % -V ’^Inspector’s Comments: • 'i Sketch: OTTtBTtATi. UvAltb" CAbtriS inspector s Signature “ D’a7e be InspectionIlllAjC AVS Time of inspection 1 M.H, } COVER • r-^^CN > -7fH iB54 B53 B55 \ \r.s \. Chuck aSu Jean Malmstfoiit^-----T ------•\^fcac/se/i s LCSOr/Rt 2, Battie^XSK^ MinB.- 5S5ia ___^-1328---- White — Office Yellow — Owner Pink — Assessor Goldenrod — Inspector SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT Permit No. IfoM fi- rr)^ £ 6.']5 fi-3r^HjcLLdZ-6 4. LEGAL DESCRIPTION AND LOCATION I i_ JiB. M TWP NameTWP RangeLake Classif.Sec.Lake NameLake No. IDENTIFICATION: Please Print All Information Tel. No.First Initial Zip No. ______ Mailing^ Address— No. Street, City and State V/If7.S^nvdjJrJfYn / Last Name Owner i NameContractor Architect Name. NON-RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT: (^(fNew Building ( ) Alteration RESIDENTIAL PROPOSED USE: One Family Dwelling ( ) Multiple Dwelling ( ) Other . Specify:, Units X ^ ^'( ) Other Size ESTIMATED COST OF IMPR0VEMENT|$ DIMENSIONS: Basement: ( ) Yes No Stories above basement: ...... Sq. feet (outside dimension) .... Bedrooms TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME: D.( ) Masonry Wood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public Individual Well .../Baths CHARACTERISTICS: BM..Z Maximum depth of lot feet.Water frontage is ....^»;feet.square feet.Lot Area is atBuilding 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. (Building LinefeeV^ feet.feet — from road right of way is and ............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).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. TH/S 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. niiDated.Are of Owffl 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. . fh) Dated Shoreland MaHag'ern^nt Official Permit Fee $.Receipt No. Comment //-g-/y. Form No. MKL-0286-019 229971® VICTOR LU.VDEEN CO., PRiNTKRS. FERGUS FALLS, MINN. ^ ini' C(y^ White — Office Yeilow — Owner Pink — Assessor Goidenrod — inspector SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 — Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT 0 /• // . ^j'/j Ciiu^dT ■ (</:. L.Permit No. > _.'c /.' LEGAL 4-/ (AJ S:67" •'V ‘ / ; -'1 i ' I t. A / ■ T~( I , i .DESCRIPTION r<. 4.AND yLOCATION i IIII4 n ! TWP Name *TWP RangeSec.Lake Ciassif.Lake NameLake No. IDENTIFICATION: Please Print AM Information Zip No.Tel. No.Mailing Address— No. Street, City and StateInitialFirstLast Name ///.,S/,' // /;Owner i—1.- NameContractor ■Y , ~ TO fArchitectName. ER NON-RESIDENTIAL PROPOSED USE;RESIDENTIAL PROPOSED USE;TYPE OF IMPROVEMENT; (\^ One Family Dwelling ( ) Multiple Dwelling ( )Other Specify:.(/‘^New Building ( ) Alteration ( ) Other_______ Units /Size ESTIMATED COST OF IMPROVEMENT $ DIMENSIONS: Basement: ( ) Yes No Stories above basement: ....... Sq. feet (outside dimension)..... Bedrooms TYPE OF SEWAGE DISPOSAL;PRINCIPAL TYPE OF FRAME:'.rS-b.( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public (^ Individual Well ( ) Masonry (x.| Wood Frame ( ) Structural Steel ( ) Other — Specify J.Baths CHARACTERISTICS: ....xjAZ ..........feet. feet.feet. Maximum depth of lot (Building Line)/(iS ................feei-^ feet — from road right of way is .......... Water frontage issquare 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 ..................... Structure will be located I feet. .............feet.*-^ r' .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 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. 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. 7/ i /7 . /!'-IDated Shoreland Managerqent Official Permit Fee $.Receipt No. j ( ‘ V ' !Comments:^/L.- V ■ z. CcU)(yK -/n i) fForm No. MKL-0286-019 PR^iNTER229971®S. FERGUS FALl.S. MINN. r * I V • * INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS i MINIMUM Shall Be ^Sq. Ft, Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft.Ft. / 3o"*- Building Set Back from High Water Mark Ft.Ft. / 0 0^Building Set Back from State Highway Ft.50 Ft. y FtBuilding Set Back from Street or Road Ft. 9v'I—& ' Ft.Side Yard &Ft. Rear Yard Ft.Ft. r1 0Occupied Building to Septic Tank Ft.10 Ft. T-Occupied Building to Absorption System Ft.20 Ft.o Elevation at Building Line above High Water Mark_____________Jo" I r Ft.3 Ft. Inspector's Comments: (! ') — Z'o^v''2c7 I C P’*''S -^KV "V"^ P MO -V~V <t-V____tZ ‘vVa'Cp*'WV\\ I //^ O rV~ ^/ -i-A \ooO *Vv- 4^.£/oo\ S <> U. 'Aj .9v\ > S ' ~h / I /M Inspector s Signature Title Inspection Dated 19//- /r^Agency VICTOR LUNOICN » CO.. RRIMTCRt. FCRflUC FALL*. HIHH. SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Win. 56537 APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY White — Office Yellow — Owner Pink — Assessor Goldenrod ~ Inspector Permit No..LEGAL Date.DESCRIPTION AND LOCATION ) Lake No.Lake Classif.TWP TWP NameSec.RangeLake Name IDENTIFICATtON: Please Print All information Last Name Initial Mailing Address— No. Street, City and State__________Zip No.Tel. No.First CJfai/iP ^r/rrr\^Owner NameContractor Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE: ( ) New Building ( t+^lteration ( ) One Family Dwelling ( ) Multiple Dwelling Specify: f^dcl'r\ •/cm C,<1 Units ( ) Other ( ) Other Size ESTIMATED COST OF IMPROVEMENT $(omit cents) PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry (OWood Frame ( ) Structural Steel ( ) Other — Specify Basement: ( ) Yes (x-J-fito Stories above basement: ....... Sq. feet (outside dimensioni..... Bedrooms ( ) Public ( -pTndividual Septic Tank, etc. WATER SUPPLY: ( ) Public ( 'T-fndividual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central 1..:3..Baths HEATING: ( ) Electric ( ( ) Coal Other: ( HMoType of Roof:( ) OilGas (--KI^o I ) Nonedxrf^p ( ) Unit CHARACTERISTICS: d...A.^0.0.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 /O.. Building set back from State highway is Side yard is Building will be located Building will be located feet — from road or street is feet. Ai-o i-.^.Q,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. /o i- 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 oe^d of six (6) months. ( X aJ/ Signature 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 ail respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated ✓9 OO Permit Fee $ icA » Shoreland Management Official/State Surchiarge $. Comments; Form No. MKL-0771-002 vicrga ufHBCCH 4 e«.. FXHTiMt. rt4«u* r*Li.s. hidn.158899 ISHORELAND 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,.y-' '/■ ‘T:LEGAL Date.DESCRIPTiON AND LOCATION Sec.TWP NameLake No.Lake Name Lake Ciassif.TWP Range IDENTIFICATION: Please Print All Information Tel. No.Last Name First Initiai Mailing Address— No. Street, City and State Zip No. Owner NameContractor Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE: I ) New Building ( ) Alteration { ) One Family Dwelling ( ) Multiple Dwelling Specify:. Units ( )Other ( ) Other Size ESTIMATED COST OF IMPROVEMENT $ 50^) PRINCIPAL TYPE OF FRAME: (omit cents) TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry ( ) Wood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public I ) Individual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms Baths HEATING: ( ) Electric ( ) Coal Other: Type of Roof:( ) No ( ) Gas ( ) None ( ) Oil ( ) No ( ) Unit 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 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 shall 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 Shoreland Management Official Permit Fee $.State Surcharge $. Comments: VOT 11 F Form No. MKL-0771-002 VICTOR UIHBCIH A CO.. PRINTEOt. PCRSut FALLS. 1158899 f INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 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. Side Yard &Ft. &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: I nspector's Signature Title Inspection Dated 19 Agency vieroK LUNBieii « M.. MiNTCM. rcn«u« him.