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Home My WebLink AboutOak Park Resort_8005781_Shoreland Permits_APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 WHITE - Office . GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor PLEASE PRINT OR TYPE ALL INFORMATION Permit No. SECTION TWP NO.RANGELAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS TWP NAME ^-Z3S 3? PARCEL NUMBER (S)E-911 ADDRESS Z//^ *f^ooooC»ocSSoi3 LEGAL DESCRIPTIONpMt ^ B Co*: oi 12,92^ S (fC'£B/ ' S39£> ' 75 Sis// rt '7t ^ Daytime Phone No.Last Name First Initial Mailing Address z/n'7 2Property Owner Contractor Lie.# PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( 5 ) RCUA'ear_____ ( 8 ) Storage Structure _ 'Existing Dwelling to be removed before. ONSITE WATER SUPPLY (vfindividual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM (irf^rmit No. ^ ( ) OTLSD * This permit is only valid alter verification from the O.T.L.S.D. that a conforming sevmge system will be installed to service this lot contact Rollie Mann at 864-5533. (1 ) New Dwelling (4 ) MH/YR ( 7 ) Add’n To Non-Dwelling (10 ) Other___________ ( 3 ) 'Replacement Dwelling Detached Garage (9) WOAS CHARACTERISTICS OF PROPOSED NON-DWELLINGCHARACTERISTICS OF PROPOSED DWELLING CHARACTERISTICS OF PROPOSED WOAS OutsiOe Dimen^ Setback to\^tline _____ Setback to Ri^of Way _ Setback to OHWby Elevation Above OHWl__ Setback to Septic Tanl\ > Setback to Drainfield A Setback to Bluff / Maximum Propose(#>feight Basement / Walkout Bas^ent Total BedrOTms_ Outside Dimension Setback to Lotline OutsideX DimensioX Setback to Ktline___ Setback to Ri^of Way Setback to OHw\ 0LFt. X 4."Ft."„^ Ft. & Ft. X Ft. X Ft.'V Ft.&Ft."Ft."Ft.&Ft." ■i- Setback to Right of Way Ft." Setback to OHWL 33$ ^ Ft. Elevation Above OHWL $ Ft. Setback to Septic Tank ^/O Ft. Setback to Drainfield / Ft. ofL Ft."Ft.7 Ft.Ft. Elevation Above OHWL Setback to Septic Tank Setback to Drainfield _ Setback to Bluff____ Ft.Ft. Ft.Ft. Ft.■t. Ft.Setback to Bluff Maximum Proposed Height 3^ Ft. Bathroom Proposed ( ) Yes ()c) No Yes No Maximum Proposed H^ht ( ) Boathouse ( ) Gazebo Ft. Yes No ( ) Screen itorch ( ) Storage sWture **Project/Lotlines/Right-of-ways Must be Staked Onsite Spoil Disposal £, □ Onsite (scale drawing required) □ Offsite □ Within Shoreland Area □ Outside Shoreland Area Grade/Fill/Excavation l^roject/Lotlines/Right-dKways Must be Staked Onsit^□ Yes (scale drawing required) 9^ No CHARACTERISTICS OF LOT: Bluff Onsite____Yes ^ No.Sq. Ft.Water Frontage .Ft. (Jr‘I , $33 Total LotArea (FTr) <3 sylir, .Total Imp^ious Surface Onsite (FT2) 1.Impervious Surface Ratio:X100 =.% Impenrious Surface Ratio THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resource Mam It office once the building footings have been constructed. Date: \tufe Of Property Owr^ Date: Land & Resource Management Office** 330>I 37$. ooPERMIT FEE $RECEIPT NO. 3>P % r3^dk ^ 6rt(lA<G(: LUiLL 6e pLACCQ Of/ l^rvf fch\S7I^C ^LA& /Q6PLACCS /TMr Bu£wCO Ocla^/v/ /a/^4>Ccp ^ Project/Lotlines/Right-of-Way MUST be Staked Onsite Prior to Submission of Application.Comments: Form No. BK — 0500-0201 304.202 • Victor Lundeen Co., Printere • Fergus Falls. MN • 1-900-346-4870 •^5«I qVAPPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE 121 W. JUNIUS AVE. • SUITE 130 WHITE - Office GOLDENROD - Inspector YELLOW - Owner (after issue) PINK - Assessor 1 ;;1 Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 expired ■1 PLEASE PRINT OR TYPE ALL INFORMATION Permit No.iSECTIONTWP NO.RANGELAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER CLASS TWP NAME J/i[ c.3?/5^2L- S-E-911 ADDRESSPARCEL NUMBER (S) ^ Y^/0<DO ^//// LEGAL DESCRIPTION ' ^ ^ ^ ^ ^ p/fAt 6>L & eo< ^es ^9/'sirQ> c>€.<) cj 8// -ro a/ ^S^/, y(/¥9/ ^ pgy iJ fz.9z3 S 6^C'^9/ ' S39^ ' 75 SsA/ to AjkS CoYycrjy^^Ci,a/yc£>y<^ ^ ■ I\%1; i 1 Daytime Phone No.i Last Name First Initial Mailing AddressI Z/8-S^P-3aC6~77.Property Owneri 1- t Contractor Lie.#i1I;IIi PROPOSED PROJECT (please circle the appropriate number) ( 2 ) Add’n to Dwelling ( 5 ) RCUA'ear_____ ( 7 ) Add’n To Non-Dwelling ( 8) Storage Structure (10) Other. ONSITE WATER SUPPLY (\)f Individual ( ) Public ( ) None NOTE: MN Rules Chpt. 4725 (MN Well Code) requires a 3' (minimum) structure setback to a well. ONSITE SEWAGE TREATMENT SYSTEM (trl'^rmit No. ^ t ( ) OTLSD * This permit is only valid after verification from the O.T.L.S.D. that a conforming sewage system will be inslalled to servIcB this lot contact Rollie Mann at 864-5533. (1 ) New Dwelling ( 4 ) MHA'R____ ( 3) ‘Replacement Dwelling Detached Garage (9) WOAS ‘Existing Dwelling to be removed before. CHARACTERISTICS OF PROPOSED NON-DWELLING ;,:iCHARACTERISTICS OF PROPOSED DW^LING CHARACTERISTICS OF PROPOSED WOAS Outside\ Dimenslo i\ Ft. X /OS Outside Dimensi Setback to TsQtline _____ Setback to Ri^of Way _ Setback to OHw\ Elevation Above 0H7(L__ Setback to Septic Tank\ , Setback to Drainfield A Setback to Bluff / Maximum Propose/lHeight Basement / Walkout Bas^ent Total Bedrooms _ Outside Dimensionay B. 0f-■V Setback to Mine___ Setback to Rig)t(^of Way Setback to OHWL' •t.“Ft.** ^ Ft.& Ft.** Ft. X Ft.*> Ft.&Ft.**Setback to Lotline Setback to Right of Way Ft.**Ft.& ■'nFt.**Ft.** Setback to OHWL Elevation Above OHWL Setback to Septic Tank Ft.Tt^rx. f\)Onj€ UiSd> Ft.Ft.H~ S Ft.Elevation Above OH'Ft.Ft. iSetback to Septic Tank Setback to Drainfield _ Setback to Bluff____ Ft.Ft. Setback to Drainfield Setback to Bluff Maximum Proposed Height Ft. Bathroom Proposed ( ) Yes ()c) No Ft.3- Ft.[t. Yes No Maximum Proposed H|ight ( ) Boathouse ( ) Gazebo Ft. Yes No ( ) Screen'^rch ( ) Storage Shjcture JIJ **PrDject/Lotlines/Right-of-ways Must be Staked Onsite Spoil Disposal rs)Ov^ £ □ Onsite (scale drawing required) □ Offsite □ Within Shoreland Area □ Outside Shoreland Area Grade/Fill/Excavation /Project/Lotlines/Right-df-ways Must be Staked Onsit^□ Yes (scale drawing required) ItfNo CHARACTERISTICS OF LOT: Lot Area^^^ 9^3 \ :23 Yes No.Sq. Ft.Water Frontage Bluff Onsite..Ft. 1%Impervious Surface Ratio:T X100 =.% Total Impenrious Surface Onsite (FT»)Total Lot Area (FT*)Impen/lous Surface Ratio THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STATE STATUTES. Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set forth and according to the provisions of the Ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the Ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said Ordinances. I understand that it is my responsibility to inform the Land & Resource Management office once the building footings have been constructed. i ^jgrtature of Property OwrSer Date: 7S.0O tS ‘■Of Date: ChL ** 330,Land & Resource Management OWceI 33^4^PERMIT FEE $RECEIPT NO. Project/Lotlines/Right-of-Way MUST be Staked Onsite Prior to Submission of Application.Comments: IUYILL fi/r pLA«0 drY / f^r^Pt.-KTS <2aKA<3C ‘1 Form No. BK — 0500-0201 304,2(32 • Victor Lundeen Co.. Printers • Fergus Falls, MN • 1>800'346'4670 > SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations . r+“Structure Set Back from Ordinary High Water Level Ft.Ft.O Structure Set Back from Top of Bluff Ft.Ft. iStructure Set Back from Road Right of Way Ft. Ft. i Ft. & < O ^Structure Set Back from Lot Lines Ft.Ft.Ft.& ) 2.- i 4 'Structure Height Ft.Ft. Structure Set Back from Septic Tank Ft.Ft. Structure Set Back from Drainfieid Ft.Ft. Eievation Of Lowest Fioor Above Ordinary High Water Levei -t-Ft.3 Ft. Land Slope at Building Site %% 2.^1' K -2,4 Inspector’s Comments / Sketch: ] 1 Inspector's Signature I on0 2^ Date of Inspection 2 i Time of Inspection Q Project Approved Date/Initial feetinch(es) equalsfeet, or.grid(s) equalsScale:1 Please use this sheet for the required scale drawing of your proposal. Be sure to include lot dimension, water frontage, and setbacks from RW, lake, lot lines, sewage system, top of bluff, existing structures and all imper vious surface. Required impervious surface coverage calculation (See definition in Shoreland Management Ordinance) %X 100 = Total Lot Area (FT2) Total Impervious Surface Onsite (FT2) )I r-C3|; I % * ^-H- c>3 DatedSignature BK — 0500 — 029 304,378 • Victor Lundeen Co.. Printers • Fergus Falls, MN • 1-800'34e-4870 r 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 ^ns~3Permit NoLEGAL DESCRIPTION AND G. .L G ______________________________h/ / ■ (/ !3 ^ 3*7 > LOCATION FUG- TWP NameLake Classif.Sec.TWP RangeLake No.Lake Name IDENTiFICATION: Please Print All Information Tel. No.Mailing Address— No. Street, City and State Zip No.Last Name First Initial o \ \ t- /■ ''A MT\Owner t NameContractor Architect Name. TYPE OF IMPROVEMENT; ^(\J^N^ Building ( ) Alteration ( ) Other RESIDENT^L PROPOSED USE: \L-One Family Dwelling ( ) Multiple Dwelling NON-RESIDENTIAL PROPOSED USE;/ X 7 ^AicL'i! ‘L. 1'^ 0 (Specify:, Units ( ) Other Size ESTIMATED COST OF IMPROVEMENt|$ PRINCIPAL TYPE OF FRAME;TYPE OF SEWAGE DISPOSAL:DIMENSIONS: / o( )Masonry (vO Wood Frame I ) Structural Steel ( ) Other — Specify ( ) Public ( ) Individual Septic Tank, etc. Basement: ( ) Yes ( Stories above basement: Sq. feet (outside dimension) Bedrooms .............................. / WATER SUPPLY: ( ) Public (•G^ndividual Well Baths ...|........... tOi irhAType of Roof: CHARACTERISTICS: square feet.Water frontage is feet.Maximum depth of lotLot Area is 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 feet. (Building Line) .a.feet Vfeet — from road right of way is feet. / o'and feet. LaStructure will be located .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 forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewit; shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. se THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STA TE STA TUES.Signature of Owner Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon the en shall conform in all respects to the ordinances of Otter Tail Permit: express condition that the person to whom it is granted, and his agent, employees and worki County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated Shoreland Management Official Permit Fee $ G/Q • ^ fCommentsT^'ho SQa O \ -VA '>-y-T r 0 / 195676®Form No. MKL-0771-002 VICTOR LUNOCEN CO., PRINTERS, FERGUS FALLS. MINN. •W' 'M' ■✓-—"-w^.'*-- art' .'■T^TVr 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. —^ i k. k'LEGAL k s c; rDESCRIPTION AND -L a/ / b S ■LOCATION Uu—-6 (:3'‘// j '2 L.. Lake Classif.TWP NameTWPRangeSec.Lake No.Lake Name IDENTIFICATION: Please Print All Information Zip No.Tel. No.Mailing Address— No. Street. City and StateLast Name InitialFirst 1/1 /V'I 1Owner NameContractor Architect Name. TYPE OF^PROVEMENT: , (V Ns'Y Building ( ) Alteration RESIDENCE PROPOSED USE: ( \).-One Family Dwelling ( ) Multiple Dwelling NON-RESIDENTIAL PROPOSED USE:/ icT / 0 Specify:,]• Units i-V,rV-vA-,( ) Other ( ) Other Size ESTIMATED COST OF IMPROVEMENT $ PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS: vPno'<. C ( ) Individual Septic Tank, etc. r \( ) ^lasonry (v1 Wood Frame ( ) Structural Steel ( ) Other — Specify ( ) Public Basement: ( ) Yes ( Stories above basement: Sq. feet (outside dimension) Bedrooms .................................. / WATER SUPPLY: ( ) Public (ikindividual Well Baths ...I., Type of Roof: CHARACTERISTICS: square feet.Water frontage is / :■ c/ feet.Maximum depth of lotLot Area is feet. Building set back from high water mark is, Land height above high water mark at building line is feet. (Building Line) .J.feet VCj Building set back from State highway right of way Side yard is feet — from road right of way is feet. I iIand feet. i ,l7.Structure will be located ,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 forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewit shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months. se THIS IS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA ST A TE ST A TUES. i -■•1 ■f : y l , -^ Mi ' • 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. - .^3Dated Shoreland Management Official Permit Fee $. ( ...1CommentsiJi//7 \\V I..! >. \. ‘ 195676® Form No. MKL-0771-002 VICTOR LtfNOCEN CO.. PRiNTfiPS. FA..L8. INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS 1 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 40 Ft.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 VlCTOt UINPtCN • CO . PRIHTCa*. rC««U« FM.L*. MINK. 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 ) & -,3 ff/’Permit No„LEGAL Date.DESCRIPTION T^c/ , To3/^7AND LOCATION /ed L /Sj. TnuJ. Lake Classif.Sec.TWP TWP NameLake No.Lake Name Range IDENTIFiCATtON: Please Print All Information l^st Name First Initial Mailing Address— No. Street. City and State Zip No.Tel. No. /a ^ yybr\ •Owner //V> A/y~■t NameContractor Architect Name. TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE;NON-RESIDENTIAL PROPOSED USE: ( ) New Building ( ^reiteration ( ) One Family Dwelling ( ) Multiple Dwelling Specify:. Units > fJ ) Other ( ypOTher Size ESTIMATED COST OF IMPROVEMENTS l&'OQ*(omit cents) PRINCIPAL TYPE OF FRAME: TYPE OF SEWAGE DISPOSAL:DIMENSIONS: ( ) Masonry (uHWood 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 ( ) 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 dofeet — from road or street is feet. u.C^.Oand 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 (jermit application. I also understand that this permit is valid for a period of six (6) months. Dated. Signature Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit; express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Shoreland Management Official JT Dated . 1sSPermit Fee S c2,- ^ ^State Surcharge $. Comments: a~ a.0 V io' . ItwJIvl duLYv-v cL Vc X.;^p\o.CJL^ O. rLOo~>oa Form No. MKL-0771-002 VIOTCt UiMtlM 4 M„ MIITIM. rtllMC FALkl, HWN.158899 SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL COUNTY COURT HOUSE Phone 218-739-2271 - Fergus Falls, Mn. 56537 APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY White — Office Yellow — Owner Pink — Assessor Goldenrod — Inspector Permit No„4-LEGAL Date.DESCRIPTION .'■X AND LOCATION Sec.TWP Range TWP NameLake Classif.Lake No.Lake Name IDENTIFICATION: Please Print All Information Mailing Address— No. Street. City and StateLast Name First Initial Zip No.Tel. No. Owner NameContractor Architect Name, TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE: I ) New Building ( ) Alteration ( ) One Family Dwelling I ) Multiple Dwelling Specify:, Units ( ) Other ( ) Other Size 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 ( ) None ( ) NoType of Roof:( ) Oil , .( ) No ( ) Coal Other:( ) 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; ' X NOT CA-LUgP FTI.FD Form No. MKL-0771-002 v>er«a LuneciH 4 eo.. Mianat. fcasut rM.Lt. 158899 INSPECTOR'S CHECK LIST Make all measurements and computations ACTUAL IS i 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. 50 Ft.Building Set Back from State Highway Ft. 40 Ft.Building Set Back from Street or Road 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 VlCTOK UINPCBM • M . MlMTt) I