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Home My WebLink AboutMurray Point_35000170169000_Shoreland Permits_Grade & Fill Permit PROPERTY OWNER pT" LAKE N0.5^!^Liiy_ SEC. 11 TWP. NAME Uk<^^ A Q C- (jC^3______ 3820 LEGAL DESCRIPTION: ^V\Qv><^l‘\K4^ »rv\ee^ ClU "bNg-^ Y*uy> *^V*» V ^o\ ( A.»^-(r iro S.WiW — Oo»N*Vl^«^C/V^v^- WORK AUTHORIZED ip ^v*~^ Ary<-»^ ^Kpq-s«>4 Coo'^S ct4~ ^r V o “t S4-0.Vkc> , F-\U cArrv(7 irv V Vo p«^.Vottv >r\p ^-«^pV<l«^ pyo\»-<jV jV^_ A *~»vJL ^ ~^rCfcS/Vv\c , ^ ot“ ^ V“ovAC W^XV Tnis card sHall be placed in a conspicuous place not more than 4 feet above grade on the premises on whichNOTE; work is to be done, & shall be maintained there until completion of such work. NOTIFY LAND & RESOURCE MAN AGEMENT, 218-739-2271 WHEN AUTHORIZED WORK HAS BEEN COMPLETED. & 9-/Si-ov/1. EARTHMOVING SHALL BE DONE BETWEEN 8-T:^ 2. Entire area shall be stabilized within 10 days of completion of any earthmoving. 3. Owner is legally respon^le for all surface water drainage that may occur. 4. No fill shall enter or be taken from the beds of public water without a valid permit from the MN Department of Natural Resources. 5. If the terms of this permit are violated, the entire permit may,be revoked and the owner may be subject to legal prosecution. 6. Erosion control measures must be implemented prior to any topographical alterations. GRADE & FILL APPLICATION LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER T/VIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MNT ‘56537V£n 218-998-8095 t www.co.otter-tail.mn.us PERMIT NO. ^ Q Application Fee Receipt Number V/Ima MAILING ADDRESS DAYTIME PHONE NUMBER ( S'SV- LAKE NAME PROPERTY OWNER!' fJDdjMWU f}lNCITY, STATE, ZIP ^ i.CLASSLAKE NO. PARCEL NUMBER (S) SECTION^RANGE CO TWP NAMETWP Cc:irrif.LEGAL DESCRIPTION ■ it E-911 PROPERTY ADDRESS NOTES: 1. The lotlines and project area(s) must be staked. 2. If project disturbs more than 1 acre of land you are required to obtain a General Storm Water Permit from the MPCA. Received L&R Official DATE PROJECT REQUEST (provide the scale drawing on back): jr"MAXIMUM DEPTH OF CUT:FT. MAXIMUM DEPTH OF FILL:FT. Cjrfimr■ SMI 6/)au) YDS*TOTAL CUBIC YARDS OF EARTHMOVING REQUESTED: DESCRIBE YOUR PROJECT BELOW: Rp' auzi OrA Aii Jo' AyJL oiL a'kZO/A njoJL Mjl p<dyJi , SIGNATURE OF PROPERTY OWNEFUAGENT FOR OWNER DATE BK0404 318.312 • Victor Lundeen Co . Printers • Fergus Falls, Minnesota Scale «( y "jr tiL^clU !d^ \ uo Signature Date BK — 0404 — 029 318.312 • Vtcior Lundeen Co., Printers • Fergus Falls. MN • 1-800-346-4870 APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE — Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor i(a ~ ^ 0-f ^ 3 n - / ^2^ A/ 94 ^cls /2301Permit No.LEGAL DESCRIPTION AND LOCATION LAKE/RIVER NAME SECTION TWP NO.RANGE TWP NAMELAKE NUMBER LAKE/RIVER CLASS t;?J5 /3/ 3? PARCEL NUMBER (S)FIRE OR LAKE ASSOCIATION NUMBER35-060 -)(s- O -coo 3^-000 -/?- 0/65 ' ODO IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City and Slate Zip Code Telephone No.First InitialLast Name Mu-TrcXM Po i‘<a+, *Po So% 5Property Owner Alctry AtLcY’V^ccy 5V-, t\J Ssy% SJANameContractor State Lie. It PROPOSED USE RESiDENTiAL USE NON-RESiDENTiAL USE ( ) Garage ( X,) Utility Structure ( ) Water Orientated Accessory Structure CHARACTERISTICS OF PROPOSEDPROPOSED PROJECT (MO) Residential Non-Residential { ) New Structure (^ Addition/ ( ) MH/RV ( ) One Family Dwelling ( ) Multiple Dwelling # of Units ( ) Basement ( ) Walkout Basement ( Outside Dimension of Structure______ ) X i Ft. C. Ft. YEAR TYPE OF FRAME ( ) Masonry ( ^ Wood ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY ( ) Other Height of Structure # Of Stories______/( ) Public ( Individual ( ) None OFFICE USE ONLY (■^4/ Bluff Impact Zone ( \) Shore Impact Zone ) Sensitive Area ( ) Public (;c) ( ) OTLSD if Of Bedrooms^06Individual —Permit ft -53O O # Of Bathrooms ( LOT SIZE AND SETBACKS:•AsquQi'o fcot.~^ Water frontage isLot Area is feet. Maximum depth of lot feet. Building set back from ordinary high water level is feet. (String Test) <3Land height above ordinary high water level at building line is :^a feet. Slope of lot % Building set back from road right-of-way.feet. 30 ^ andLot line setback is feet. / DStructure 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 Tall 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 ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CH^ER 76, MINNESOTA STATE STATUTES. (pres^ 3 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 gra condition that the person to whom it Is granted, and his agent, employees and workmen shall conform ip. all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. 3^. Dated: upon the express 2-*?-93Dated: Land & Resource Management Office Permit Fee .F I.||3,?3Receipt No_ Comments: Form No. BK — 0292-002 262,316 — Victor Lundeen Co., Printers, Fergus Falls, Minnesota APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE — Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor /6 - So.Lfo'i' o'f 6- / 3 /2301Permit No.LEGAL i'.' DESCRIPTION - iAND LOCATION "■ SECTION TWP NO.RANGELAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS t , 3 5-0(20- )Iq ~ o ^ 3S-000 '/?- 0/6^ ^ aD(2> TWP NAME 3^^ - If ^ Ls.If /3/3? PARCEL NUMBER (S)FIRE OR LAKE ASSOCIATION NUMBER IDENTIFICATION: Please Print All Information First Mailing Address — No. Street, City and State Zip Code Telephone No.Last Name Initial /M urTO + , r.ac_.fo Soj. 19 HI <1Property Owner Al^ry ^•AluY’V^ay ‘-fqyS-f, /lyf) cln a f I, t\J £132L SAfNameContractor State Lie. # PROPOSED PROJECT ( ) New Structure Addition^ ( ) MH/RV PROPOSED USE (/yfc>) Residential Non-Residential RESIDENTIAL USE NON-RESIDENTIAL USE ( ) Garage ( X.) Utility Structure ( ) Water Orientated Accessory Structure ( ) Other CHARACTERISTICS OF PROPOSED ( ) One Family Dwelling ( ) Multiple Dwelling # of Units ( ) Basement ( ) Walkout Basement ( Outside Dimension of Structure ) Ft. L ^Ft. YEAR TYPE OF FRAME ( ) Masonry ( ^ Wood ( ) Structural Steel ( ) Other ONSITE SEWAGE DISPOSAL SYSTEM ( ) Public ( ) OTLSD ONSITE WATER SUPPLY Height of Structure # Of Stories______z{ ) Public ( ~)() Individual ( ) None OFFICE USE ONLY (^T) Bluff Impact Zone / { h Shore Impact Zone ( /) Sensitive Area # Of Bedrooms ft Of Bathrooms i LOT SIZE AND SETBACKS: Lot Area is sc|uare feet. Water frontage is feet. Maximum depth of lot feet. 1Building set back from ordinary high water level is feet. (String Test) 3Land height above ordinary high water level at building line is feet. Slope of lot % Building set back from road right-of-way..feet. — Klitf and / iO 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). Lot line setback is feet. Structure will be located /zStructure 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 Tall 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 ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. / /Z:Dated: S/gnafure of Owner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement.. This permit is grahted upon the express condition that the person to whom it is granted, and his agent, employees and workmen shall conform iQ^ all respects to the Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. i' Dated: Land & Resource Management Office Permit Fee $ .3^^'—Receipt No. ( j j Comments: ^3^-0---a TT Form No. BK — 0292-002 2^,316 — Victor LurKtoen Co.. Rrintors. Fergus Falls, Minnesott y J INSPECTION RESULTS Make all measurements and computations \i ACTUAL MINIMUM Sq. Ft. Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft.Ft. 1 Cr-t ■'f"Building Set Back from High Water Level Ft.Ft. ■iSGr fBuilding Set Back from Top of Bluff Ft.30 Ft. r 7c> Ft.Building Set Back from Road Right of Way 20 Ft. ^ it"Building Set Back from Lot Line Set Back Ft. &Ft.Ft. f Itv Building Height r‘ Ft.Ft. lOtBuilding Set Back from Septic Tank Ft.10 Ft }■€> -fBuilding Set Back from Absorption System Ft.20 Ftc5 Elevation Above High Water Level at Building Line do 3 Ft.Ft. Le4^i*>1Land Slope at Building Line %I ” ! lUInspector’s Comments:i■f /I/I / \ ■ Sketch Inspector's Signature yr^ :r y \y Tiafe ot Inspectioni \fov Time of inspection i Scale: Each grid equals feet/inches GRID PLOT PLAN SKETCHING FORM JDated:19 Signature Please sketch your lot indicating setbacks from road right-of-way, lake and sideyard for each building currently on lot and any proposed structures. V I- ! Pro rj 1I <(( I i I i I !.ri\r'i V. r L. 'TsHr, r. Jt- iilOl I i 1. 215987®MKL-0871-029 VICTO* lUMOECN CO.. 9KINTERI. FCD«ua PALLS. yiNH. Department of LAND & RESOURCE MANAGEMENT COUNTY OF OTTER TAI L Phone 218-739-2271 Court House Fergus Falls, Minnesota 56537 MALCOLM K. LEE, Administrator RECEIVED AUG 1 9 1985Asher & Franny Murray SE 5th St Wadena, MN 56482 COUNTY ATTORNEY RE: Permit #6361 for 18 x 20 dwelling on West Leaf Lake, (56-114), Lot 1 Ex N 96 Rds. Dear Asher & Franny: In checking the Otter Tail County tax files we discovered that the above referenced property is owned by a corporation, therefore, the permit will need the approval of the Chief Executive Officer of Murray Point, Inc. before we can honor it as a valid permit. The permit is null and void until the approval is secured by this office. Sincerely, Malcolm K. Lee Administrator cc: Dr Dave Nielsen 848 11th Street Manhattan Beach, CA 90266 Michael Kirk County Attorney ckJl ^ i SHORELAND MANAGEMENT ORDINANCE - DIVISION OF EMERGENCY SERVICE - SUBDIVISION CONTROL ORDINANCE SOLID WASTE ORDINANCE SEWAGE SYSTEM CLEANERS ORDINANCE - RECORDER, OTTER TAIL COUNTY PLANNING ADVISORY COMMISSION RIGHT-OF-WAY SETBACK ORDINANCE FUEL AND ENERGY COORDINATION 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 Lo'f / A A:k Permit NoLEGAL DESCRIPTION AND LOCATION Lecrf H 3S~ TWP NameLake Classif.Sec.TWP RangeLake No. Lake Name IDENTIFICATiON: Please Print Ail Information Tel. No.Zip No.Mailing Address- No. Street, City and StateLast Name First Initial -/nurr^y xtrP Owner V NameContractor Architect Name. TYPE OF IMPROVEMENT;NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE; /)VLt>f lhnej. ai)o\j^ hiSU.KC _______ Specify:,( ) New Building One Family Dwelling ( ) Multiple Dwelling<yAlteration Units ( )Other ( )Other Size ESTIMATED COST OF IMPROVEMENt|$ TYPE OF SEWAGE DISPOSAL;PRINCIPAL TYPE OF FRAME:DIMENSIONS: Basement: Yes ( ) Stories above basement: ( ) Masonry (^4jNood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public Individual Septic Tank, etc. WATER SUPPLY: ( ) Public Sq. feet (outside dimension) ... Bedrooms .........../................ Individual Well Type of Roof: CHARACTERISTICS: feet.Water frontage is Maximum depth of lotsquare feet.feet.Lot Area is im....Building set back from high water mark is.................... Land height above high water mark at building line is Building set back from State highway right of way.... Side yard is Structure will be located feet. (Building Line)s feet so..feet — from road right of way is feet. /.h10 feet.and .0.■feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.).BO.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. of Owner L THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUES. tSignatiJre 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. 10 <raL'cask' Dated Shoreland Management Officii XZr€cPermit Fee $. A^rh»h__UjJ.// i-E._CUX __s-eihck____________ Lu/ifck /.f r/o<F>t^Comments: 195676® VICTOR U;nDCEN CO.. PRiNTKRS. FERGUS FALLS. MINN.Form No. MKL-0771-002 While - Office Yellow — Owner PInIc — Ae*^essor Goldenrod — Inspector SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739 -2271 - Fergus Falls, Minnesota 56537 APPLICATION FOR SITE PERMIT i / Ldi (Permit No,__‘•OA' %LEGAL DESCRIPTION AND LOCATION / /./V ~}iiJ Lake No.TWP NameLake Classif.Sec.TWP RangeLake Name IDENTIFICATION: Please Print All Information Tel. No.Zip No.Mailing Address— No. Street. City and StateLast Name First Initial ■ Owner • /./* NameContractor Architect Name. TYPE OF IMPROVEMENT:NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE: ^ -j One Family Dwelling ( ) Multiple Dwelling . /fy^O( ) New Building C')4 Alteration ( ) Other Specify:. Units ( )Other Size ESTIMATED COST OF IMPROVEMENt|$ PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry ( ) Wood Frame ( ) Structural Steel { ) Other — Specify Basement: { ) Yes ( ) No y( ) Public (, ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public t- ) Individual Well Stories above basement: Sq. feet (outside dimension) Bedrooms ...........J................. Baths..... Type of Roof: CHARACTERISTICS: ...'.j.square 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 right of way..... Side yard is ...................... Structure will be located Water frontage is feet.Maximum depth of lotLot Area is feet. ;feet. (Building Line)...Vi feet.V... feet — from road right of way is feet. and feet. .feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.).Structure will be located Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above 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 STATUES.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. .V ^Dated Shoreland Management Official/'ft Permit Fee $. Comments:/ .< f i- CALLEO KCl 195676(^ VICTOR LUNOEEN CO.. PRINTERS, FERGUS FALLS. MtNN.Form No. MKL-0771-002 L I H INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 1 MINIMUM Shall Be -4-Sq. Ft. Lot Area (Square feet)Sq. Ft.Sq. Ft. Water Frontage Ft.Ft. Building Set Back from High Water Mark Ft.Ft. Building Set Back from State Highway Ft. 50 Ft. Building Set Back from Street or Road Ft. 40 Ft. 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: Inspector's Signature Title Inspection Dated 19 Agency vicTgR ujMcicM ft eg., primtciii. rfsauft rALct. mi«h. SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY White — Office Yeilow — Owner Pink — Assessor Goldenrod — inspector * \5vjlVd\c)'V' (V Gj-ovt. V. tj-V _3i /(j? i'rs hc>ir^' Tu P jlJA^ M / !' ^0^/Do0 jUS }\l U>j .7/^ UJ Lake No. La|^ Name ~ Lake Classif. 'Sec. TWP Range_____ / TWP Name s/nj vxr. Permit No.LEGAL Date.DESCRIPTION AND LOCATION IDENTIFICATION: Please Print All Information Tel. No.Zip No.Mailing Address— No. Street. City and StateFirstInitialLast Name I n s eir-r AyOwner ^CrjTTjT /ii __.M iName 7^Contractor Architect Name. NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE: (Uf^ne Family Dwelling I ) Multiple Dwelling TYPE OF IMPROVEMENT: aecifv: ^ -( ) N^ Building ^ (4^teration —''1 Units /( )Other Size( ) Other Zja-8 /(yOOESTIMATED COST OF IMPROVEMENTS (omit cents) DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME: wV^-A ^ ] oual Septic Tank, etc. / Basement: ( ) Yes ( Stories above basement: Sq. feet (outside dimension) Bedrooms .............................. ( ) Public CV ) Indivi WATER SUPPLY: ( ) Pi^c ( ‘•T'mdividual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central ( ) Masonry M-VKo^ Frame ( ) Structural Steel ( ) Other — Specify 1.(7.52. Baths HEATING: ( ) Electric ( ) Coal Other: ( ) Gas ( ) None ( ) Oil(Type of Roof: ( ( ) Unit itCHARACTERISTICS: J^As/AIA feet.Water frontage is feet. (Building Line) feet square feet.Lot Area is 7^/.D.O.Building set back from high water mark is Land height above high water mark at building line is Building set back from S^te highway is Side yard is........................... Building will be located Building will be located a.feet.feet — from road or street is ail feet.feet. Rear yard is feet from septic tank (Sewage System Permit must be obtained before installation), feet from soil absorption system (Cesspool, Drainfield, etc.). and-f-f O SI: 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 thi& permit application. I also understand that this permit is valid for a period of spimB) ivonths. I Dated. Signature' of Owner Permission is hereby granted to the above named applicant to perform the work described in the above statement. TJjis permit is granted upon the the ordinances of Otter Tail Permit: express condition that the person to whom it is granted, and his agent, employees and workmen County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. conform in all respects Dated Shorelan^^jlfiagement Official State Surcharge $.Permit Fee $. Comments: Form No. MKL-0771-002 158899 VICTOt LUHOCIa k CO.. FRIRTIM. rtt«U« FN.LS. SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 — Fergus Falls, Mn. 56537 APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY White - Office Yellow — Owner Pink — Assessor Goldenrod — Inspector « A C)\V-;.' ■ - \Permit No„LEGAL Date_DESCRIPTION ;AND ! LOCATION TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTIFICATION: Please Print All Information Last Name initial Mailing Address— No. Street, City and State Zip No.Tel. No-First 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 V ESTIMATED COST OF IMPROVEMENT $(omit cents) PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry ( ) Wood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. WATER SUPPLY: ( ) Public ( ) Individual Well MECHANICAL EQUIPMENT : Elevator: ( ) Yes Air Conditioning: ( ) Yes ( ) Central Basement: ( ) Yes ( ) No Stories above basement: Sq. feet (outside dimension) Bedrooms Baths HEATING; ( ) Electric ( ) Gas ( ) Coal Other: Type of Roof:( ) No L ) Oil ( ) No ( ) None ( ) Unit I 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 1 / 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; FILED NOT CALLED Q 29 78 Form No. MKL-0771-002 @ VICT»« LUNDICH 4 M.. MMItM. PCMU4 FM.Lt.1158899 I A, INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 4r MINIMUM Shall Be 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 20 Ft.Ft. Elevation at Building Line above High Water Mark_____________Ft.3 Ft. Inspector's Comments: Inspector's Signature Title Inspection Dated 19 Agency VICTO* LUNDEEN A 60.. MlMTEI •‘'r ’• 4* ’i ‘ -..•i