HomeMy WebLinkAboutOhana Resort_37000320179000_Septic System Permits_https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=2&app=3834
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OTTER TAIL COUNTY
Land & Resource Management
Phone (218) 998-8095
Sewage
Treatment
System Permit
PERMIT TYPE PERMIT NUMBER 25494
PROPERTY OWNER Arturo & Erika Escobar
LAKE INFORMATION Lida
DNR ID(S)747
LOCATION
Parcel(s): 37000320180001
Township Name:
Property Address(es): 23644 STATE HWY 108
Legal:
WORK AUTHORIZED
Installing 5 - 1500 gallon holding tanks for RCU Sites 11-15 (one
Michelle Jevne 08/20/2018 02:44 PM
375e24d73800b83329fcd 1 f255fcedf3
6eedb 168b321 f9ccf776673a 5a06dd2a 08/20/2018 08/20/2019
ISSUE DATE DATE EXPIRESLand and Resource Management Official/Date
NOTE:
• This permit must be placed in a conspicuous place not more than 6 feet above grade on the
premises on which work is to be done, and must be maintained there until completion of
such work.
• If the terms of this permit are violated, the entire permit maybe revoked and the
owner/contractor maybe subject to legal prosecution.
• Property Owner is legally reponsible for all surface water drainage which may occur.
• Topographical Alteration projects shall be stabilized within 10 days of the completion unless
otherwise stated.
• No part of the Septic System shall be covered until it has been inspected or approved.
• Notify Land & Resource Management when job is ready for inspection (218) 998-8095.
This System will be ready for inspection on
6 the year of i at
a.m., p.m.
5;^Date Received Time Received
L & R Official
8/20/2018,2:46 PM1 of 1
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
STA fioOTmumUUm).
OUTHOUS&
TRENCH REDUCTIONHOLDING
SEPTIC TANK UFTTANKCATEGORY/InchesRotk benches wKhFT*Capacity GLS.QLS.
7/%o( sMewalMbr.FTFTFTletback from Nearest Well
L . IPreduction / equivalent toietback from Burled Vater Suction Pipe FTFT
^A CALCULATION
lSe(in«afimntAreaf
Ietback from Burled Pipe MsWbutIng Water Under Pressure FT FTFT
XSetback from OHWL (lake &/or river)FTFT FT Ft.
\Setback from Bluff FTFT Ft*
1\ PT MOUND/AT-GRADESetback from Dwelling FT
/ FT ROCK BEDSetback from NonDwellIng FT
I FTSetback from Nearest Property Line FT Ft.Ft. X !
7/__ftc'tOSetback from RIgbt-of-Way FT FT Ft*
/■ievatlon above Restrictive Layer FT FT FT
SAND IN MOUND RUSTALLERS COMMENTS /SEPTIC TANK(s)lolding Tank / Lift Alarm QNO
« Tanks Installed)ld System Pumoed & PeCTroved nvES ONO Weep Holes f
MlManuf. _lumber of Laterals #Lateral-Pipe-Size.IN
Model#'eitoration Spacing.£L •tforationDlameter-Size.IN
(3NOUMP8'Gallons Per Minute {]Feet'ofTotal-Head-+I RLTERS OYES
/
/
tpector*8 Comments:
9tch:
s
f
gteli6 fSns
the above deacrlbed sewage system installation was found to be compliant with the provisions of the Sanitation
Code of Otter Tall County.,
As 0
0SI8 hma/itnomaai
Lands
I No. BK — 04.2014-06 9B7.34S . Vinter Lundeen Ce.. Pnmern * Vergtn Venn.
https://onegov.co.ottertail.mn.us/view.php?id=3834&viewOnly= 1 &p=Land & Resource Permit Applications
* \
Land & Resource Management
Government Services Center
540 Fir Avenue West
Fergus Falls MN 56537
Phone: 218-998-8095OTTER TflIIOOVtlTT-MlllaitOTfl
Sewage Treatment System Permit
Permit # 25494
Vaiid: 08/20/2018 - 08/20/2019
Applicant Information
Applicant Information:Name:
Ross W Seifert
Phone:
(701 )219 -4139
Lmail Address:
seifertseptic@gmail.ram
Mailing Address
47000 180th ave
Pelican Rapids MN 56572
ContractorI am the:
Is this Sewer Permit
Application for a Collector
System?
No
Contactor's License Number and Business Name
Contractor's Business Name: Seifert Septic
Contractor's License Number LI 322
Property Owner's Contact Information
Property Owner
Contact Information:
Name:
Arturo & Erika Escobar
Phone:
(701 )367 - 2927
Email Address
Mailing Address
416 3rd St NW
Sabin MN 56580 4142
Propertyjnformation
Property
Please
search by
one of the
following:
Parcel #,
name, or Physical
Address.
Click the blue
"Select" to
select
Selected:
Primary NameProperty Attributes Property Address Legal Description
Primary AddNameParcel #Property Address City Legal Description Legal Description Legal Description
ARTURO
& ERIKA
ESCOBAR
416 3RD STh3700032018000123644 STATE
HWY 108
PELICAN
RAPIDS
Is the
property
Developed or
Undeveloped?
Undeveloped
Is the
property
Irxated in the
Shoreland or
Non-
Shoreland
area?
Shoreland
8/20/2018.2:46 PM1 of3
https://onegov.co.ottertail.mn.us/view.php?id=3834&viewOnly=l&p= ,Land & Resource Permit Applications
Shoreland Information
Associated Lakes :Selected:
Lake Class LR CDLake Name DNRID
GDLida 747 56-747
Bluff;No
Project Information
Type of Installation:Residential - New
Design Flow:1 to 2,499 Gallons Per Day
JypeJl
Gravity
System Type:
EHuent Distirbution;
System Components
Type II Components: Holding Tank (Contract Required)
Depth of Well:TBI Feet
Number of Bedrooms:5
Abatement:1^
Garbage Disposal:No
Ejector No
Number of Tanks:5
Number of Lifts:0
Number of Soil Treatment
Areas:
0
Septlc/Hoidinq Tanl<(s)
Total Capacity of
Septic/Holding Tank(s):
1500 Gallons
Setback to Nearest Well:TBI Feet
Setback to Ordinary High
Water Level:
100 Feet
Setback to Bluff na Feet
FeetSetback to Dwelling;
Setback to Non-Dwelling:na Feet
Setback to Nearest Lot Line: 10 Feet
Setback to Road Right-of- 10 Feet
Way:
Documentation
File 1: '5’Attach Supporting
Documentation:Escobar_sewer_units_11 -15. pdf
Appiicant Aporovai
Applicant Signature: Ross Seifert
Date Signed:08/20/2018
I understand that checking this box constitutes a legal signaturePlease check to approve:
MichelleAttention:
Terms
Agreement
The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such
work in strict accordance with Sanitation Code of Otter Tail County, Minnesota.
Applicant agrees that the Attached Documentation submitted herewith and which is approved by a Land & Resource Management Official shall become a
part of the permit.
Applicant Further agrees that no part of the system shall be covered until it has been inspected and approved for use.
It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection.
Note
Once a permit is approved it is valid for a period of twelve (12) months from the date of approval unless otherwise indicated on permit.
A sewer permit does not include the building sewer (sewer line).
nvoice 08/20/2018
TotalCostQuantityCharge
$175.00$175.00 X 1Sewage System Permit - Licensed Installer added 08/20/2018 2:43 PM
Grand Total
$175.00Total (Paid)
Approvais
SignatureApproval
8/20/2018,2:46 PM2 of 3
https://onegov.co.ottertail.mn.us/view.php?id=3834&viewOnly=l&p=Land & Resource Permit Applications
Brittany A. Walters - 08/20/2018 2;35 PM
80cb0c50103c6c39de553fbcd09ab934
806f99275bl4ae3670da6a3ef7e4e2e3
#1 Received and Assigned
Michelle Jevne - 08/20/2018 2:44 PM
fC46eb4eb79c0ce5bdld0fa6cd9842c2
5cf37a9a7a6c914a357146784466e6f5
#2 Application Review
Michelle Jewe - 08/20/2018 2:44 PM
375e24d73800b83329fcdlf255fcedf3
6eedbl68b321f9ccf776673a5a0Gdd2a
#3 Application Approval
' ■?
8/20/2018,2:46 PM3 of 3
PRESUnED sxr R/M LINE
OF S.T.N. HO. KJOV-
ORDIHARr m
OF NORTH
BY ELEVATI
4‘S5*E 42/.<W
r-
• '330.......
I
ORDINARY man HATER UNE
OF SOUTH UDA LAKE
BY ELEVATION ON a/E/f7
V
https;//onegov.co.ottertail.mn.us/admst/viewcard.php?card=2&app=3833
OTTER TAIL COUNTY
Land & Resource Management
Phone (218) 998-8095
PERMIT TYPE Sewage
Treatment
System Permit
PERMIT NUMBER 25493
PROPERTY OWNER Arturo & Erika Escobar
LAKE INFORMATION Lida
DNR ID(S)747
LOCATION
Parcel(s): 37000320180001
Township Name:
Property Address(es): 23644 STATE HWY 108
Legal:
WORK AUTHORIZED
Installing 5 - 1500 gallon holding tanks for RCU Sites 6-10 (one tank per site)
Michelle Jevne 08/20/2018 02:41 PM
2aed1128c5017f8bc35d77af6efc6bdd
b0df2aab9fc14c399cd08e628a5ffdf3 08/20/2018 08/20/2019
ISSUE DATE DATE EXPIRESLand and Resource Management Official/Date
NOTE:
• This permit must be placed in a conspicuous place not more than 6 feet above grade on the
premises on which work is to be done, and must be maintained there until completion of
such work.
• If the terms of this permit are violated, the entire permit maybe revoked and the
owner/contractor maybe subject to legal prosecution.
• Property Owner is legally reponsible for all surface water drainage which may occur.
• Topographical Alteration projects shall be stabilized within 10 days of the completion unless
otherwise stated.
• No part of the Septic System shall be covered until it has been inspected or approved.
• Notify Land & Resource Management when job is ready for inspection (218) 998-8095.
This System will be ready for inspection on
, the year of at
a.m., p.m.
Date Received Time Received
L & R Official
8/20/2018,2:42 PM1 of 1
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
TRENCH REDUCTIONSTA (SoOTMlmuit Am).
OUTHOUSE
HOLDING
SEPTIC TANK UFTTANKCATEGORY
Inches/ GLS.Rock trenches with~l500 QLS-7FT»Capacity
/%of sidewall tor.n-FTFTSetback from Nearest Well reduction / equlv^i^to V-/. IP■Setback from BurledVater Suction Pipe__________
Setback from Burled Pipe
)l8fa1butlnfl Water Under Pressure
FTFT
I\STAFTFTFT(SelMteaiment
ISetback from OHWL <lake &/or river)FTFTFT Ft.
1 FTSetback from Bluff FT FP
/ ft MOUND/AT-GRADEns>\Setback from Dwelling FTFT
/__ft ROCK BEDSetback from Non-Dwelling FT FT
hii,m /Setback from Nearest Property Une FT FT Ft.
7Setback from RIght-of-Way FT FT Ft*
/■levatlon above Restrictive Layer FT FT FT
SAND IN ID'Ft^STALLERS COMMENTS
✓SEPTIC TANK(8)JZfvES ^QuVblolding Tank / Uft Alarm 5eTairks Installed _)ld System Pumped-&-Destroyed—0-Y-ES-----□ NO" 'Weep Holes |
Manuf..lumbervof Laterals #Lateral Pipe Size IN
Model#erlbratlon Spacing Perforation DlameterSIze'IN•tr
GaHorfS'Per-MlnuteJ ] ^Jeet-oHt3tamBga~| |FILTERSUMPS------
•pectofs Comments:
■.'i
oetch:
: i
(
■j
As of l_^|(^^th8 above described sewage system Installation
was found to be compliant with the provisions of the Sanitation
Code of Otter Tall County.
I 'OJyvv-i OfOatsfriMet/L an Official
0
z Lsnrfa Manapsmsnt Offielal
\ No. BK — 04-2014-06 agT.:<a . violof Lmaun e».. siman • Fwgin ralla.I
i
https://onegov.co.ottertail.mn.us/view.php?id=3833&viewOnly=l&p=Land & Resource Permit Applications
Land & Resource Management
Government Services Center
540 Fir Avenue West
Feigus Falls MN 56537
Phone: 218-998-8095OTTCR TfliloouitTY-niaactOTA
Sewage Treatment System Permit
Permit # 25493
Vaiid: 08/20/2018 - 08/20/2019
Applicant Information
Applicant Information:Name;
Ross W Seifert
Phone:
(701 )219 -4139
Email Address:
seifertseptic@gmail.com
Mailing Address:
47000 180th a\«
Pelican Rapids MN 56572
ContractorI am the:
Is this Sewer Permit
Application for a Collector
System?
No
Contactor's License Number and Business Name
Contractor’s Business Name: Seifert Septic
Contractor's License Number LI 322
Property Owner's Contact Information
Property Owner
Contact Information:
Name:
Arturo & Erika Escobar
Phone:
(701 )367 -2927
Email Address
Mailing Address
416 3rd St NW
Sabin MN 56580 4142
Property Information
Property
Please
search by
one of the
following:
Parcel #,
name, or
Physical
Address.
Click the blue
"Select" to
select
Selected;
Primary NameProperty Attributes Property Address Legal Description
Primary AddLegal Description NameProperty Address City Legal Description Legal DescriptionParcel #
ARTURO
& ERIKA
ESCOBAR
416 3RD STh23644 STATE
HWY 108
PELICAN
RAPIDS
37000320180001
i.
Is the
property
Developed or
Undeveloped?
Developed
ShorelandIs the
property
located in the
Shoreland or
Non-
Shoreland
area?
8/20/2018,2:42 PM1 of3
https://onegov.co.ottettail.mn.us/view.php?id=3833&viewOnly=l&p=Land & Resource Permit Applications
Shoreland Information
Associated Lakes :Selected:
DNR ID Lake Class LR CDLake Name
GDLida747 56-747
Biuff: No
Project Information
Type of Installation:Residential - New
1 to 2,499 Gallons Per DayDesign Flow:
System Type:Type II
GravityEfiuent Distirbution:
System Components
Type II Components: Holding Tank (Contract Required)
Depth of Well:TBI Feet
Number of Bedrooms:5
Abatement:
Garbage Disposal:No
Ejector No
Number of Tanks:5
Number of Lifts:
Number of Soil Treatment
Areas:
2
2 i.
Septic/Holdinq Tankfsl
Total Capacity of
Septic/Holding Tank(s):
1500 Gallons
Setback to Nearest Well:TBI Feet
Setback to Ordinary High
Water Level:
100 Feet
Setback to Bluff: na Feet
10 FeetSetback to Dwelling:
Setback to Non-Dwelling:na Feet
Setback to Nearest Lot Line: 10 Feet
Setback to Road Right-of- 10 Feet
Way:
Documentation
Attach Supporting
Documentation:Escobar_sewer_units_6-10.pdfFile 1:
Applicant Approval
Applicant Signature: Ross Seifert
Date Signed:08/20/2018
I understand that checking this box constitutes a legal signaturePlease check to approve:
Attention:Michelle
Terms
Agreement
The undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such
work in strict accordance with Sanitation Code of Otter Tail County, Minnesota.
Applicant agrees that the Attached Documentation submitted herewith and which is approved by a Land & Resource Management Official shall become a
part of the permit.
Applicant Further agrees that no part of the system shall be covered until it has been inspected and approved for use.
It shall be the responsibility of the applicant for the pemnit to notify Land & Resource Management that the installation is ready for inspection.
Note
Once a permit is approved it is valid for a period of twelve (12) months from the date of approval unless otherwise indicated on permit.
A sewer permit does not include the building sewer (sewer line).
nvoice 08/20/2018
Quantity TotalCostCharge
$175.00$175.00 X 1Sewage System Permit ■ Licensed Installer added 08/20/2018 2:41 PM
Grand Total
$175.00Total (Paid)
Approvals
signatureApproval
8/20/2018, 2:42 PM i2 of 3
j-
https://onegov.co.ottertail.mn.us/view.php?id=3833&viewOnly=l&p=FLand & Resource Permit Applications
Brittany A. Walters - 08/20/2018 2:35 PM
738bd35ab711483bl9c591cd6122e977
Ha9fa2ccblec5f6953ab50618d2ecl3
#1 Recei\ed and Assigned
#2 Application Rewew Michelle Jevne - 08/20/2018 2:41 PM
24e866205c6fd3e3d6673f755ba41ea0
881d706c73bd957705alb882453b6f60
I
#3 Application Approval Michelle Jevne - 08/20/2018 2:41 PM
2aedll28c5017f8bc35d77af6efc6bdd
bOdf2aab9fcl4c399cd08e628a5ffdf3
'i
8/20/2018, 2:42 PM3 of 3
PRESurmo sxr r/h une
OF S.TM. NO. MS5^.
;
ORDINARY m
OF NORTH
BY ELEVATk
4'5a*E 42!.c»
\
f-
BOC: fid. : 201817' .
■ ■*.
. ••
)\ORDINARY HIGH HATFR LINE
OF SOUTH UDA LAKEORDINARY HkSN HATER UNE
BY ELEVATION ON IIAI/17OF SOUTH UDA LAKE
BY ELEVATION ON O/S/17
i
CATTAILS AND AOUATK VEGETATION
https://onegov.co.ottertail.mn.us/admst/viewcard.php?card=2&app=3822
UNT Y
1
OTTER TAIL C
cv
Land & Resource Management
Phone (218) 998-8095
PERMIT TYPE Sewage
Treatment
System Permit
PERMIT NUMBER 25492
\<//
PROPERTY OWNER Arturo & Erika Escobar
LAKE INFORMATION Lida
DNR ID(S)747
LOCATION
Parcel(s): 37000320180001
Township Name:
Property Address(es): 23644 STATE HWY 108
Legal:
WORK AUTHORIZED
Installing 5 - 1500 gallon holding tanks for RCU Sites 1-5 (one tank per site)
Michelle Jevne 08/20/2018 02:38 PM
1864561 beffa30d6bf1480f218110118
147cbea04c69e2a0026b8e44fd7e8818 08/20/2018 08/20/2019
ISSUE DATE DATE EXPIRESLand and Resource Management Official/Date
NOTE:
• This permit must be placed in a conspicuous place not more than 6 feet above grade on the
premises on which work is to be done, and must be maintained there until completion of
such work.
• If the terms of this permit are violated, the entire permit maybe revoked and the
owner/contractor maybe subject to legal prosecution.
• Property Owner is legally reponsible for all surface water drainage which may occur.
• Topographical Alteration projects shall be stabilized within 10 days of the completion unless
otherwise stated.
• No part of the Septic System shall be covered until it has been inspected or approved.
• Notify Land & Resource Management when job is ready for inspection (218) 998-8095.
This System will be ready for inspection on
, the year of at
a.m., p.m.
Date Received Time Received
L & R Official
8/20/2018,2:39 PM1 of 1
;
SEWAGE TREATMENT SYSTEM PERMIT INSPECTION RESULTS
STA (ScnVeMmttArea).OUTHOUSi TRENCH REDUCTIONi-HOLDING
SEPTIC TANK LIFT TANK3ATEQORY
jrj-2 Rodfttondwsvirtlh__
pj. olsIdavwntorX.
mhiction/«(ulvalentm
c,.Inches: Capacity GLS.
//%ft FTSetback from Nearest Well
I I . R*ietback from BurledVater Sucttorr Pipe__________
ietba^ from Buhed Pipe
flsWbutlnfl Water Utwfer Pressure
FTFT
^TA CALCUL^ON
^fSolITtolmanf Aiear
>IMoT FTFTFT
V \-I??'. FTSetback from OHWL (lake &/or river)FTFT Ft.
XSetback from Bluff FTFT FT ft*
\ ^\ PT <^UND/AT-GRADE
'^OCK BED
Setback from Dwelling FT
\ FT I ftSetback from Non-Dwelling FT
1 ft /____^211Setback from Nearest Property Line FT .Ft.
I ft /Setback from Right-of-Way FT Ri
//ilevatlon above Restrictive Layer FT FT
SAND IN MOUND Ft*«STALLERS COMMENTS
SEPTIC TANK(8)lowing Tank / Lift Alarm ^fYES ONO lfV^CnVv(il
# Tanks Installed)W System Pumped & wstroved HYES )S SVy]Manuf..lumber of Laterals #LatemLPipe-SIze.IN
Model #. erforation Spacing Ft.Perforation Diameter Size IN
n^oFeet QtJotal.Head_|irGallons Per Minute [FILTERS OYESUMPS
7•pBctor's Comments:
Btch:
I ^iF , the above described sewage system installation
was found to be compliant with the provisions of the Sanitation
Code of Otter Tail County.
As of
Tlmff /h/Kaf/lAROfflbtof
{Land S ReaoinvB Management Offieiaf
\ No. BK — 04-a014-06 SBT.MS • Vletof LunSeen Co., Rrinlero • Forgus Fatlo.
https://onegov.co.ottertail.mn.us/view.php?id=3822&viewOnly=l&p='Land & Resource Permit Applications
Land & Resource Management
Government Services Center
540 Fir Avenue West
Feigus Falls MN 56537
Phone: 218-998-8095OTTER TRIl0 0 0 AT Y-n t e 0 I I O TO
Sewage Treatment System Permit
Permit # 25492
Valid: 08/20/2018 - 08/20/2019
Applicant Information
Applicant Information:Name:
Ross W Seifert
Phone:
(701 )219 -4139
Email Address:
seifertseptic@gmaii.com
r^aiiing Address:
47000 180th ave
Pelican Rapids MN 56572
Agent/DesignerI am the:
Is this Sewer Permit
Application for a Collector
System?
No
Work Performed By
Work to be performed by:Contractor
Contractor's Contact Information
Contractor Information:Name:
Ross W Seifert
Company or Business Name:
Ross Seifert Septic Service LLC
Contractor License Number
1322
Additional Phone:Phone:
(701 )219 -4139 ( )
Email:
seifertseptic(^gmail.com
/Address
47000 180th ave
Peiican Rapids MN 56572
Property Owner's Contact Information
Property Owner
Contact Information:
Name:
Arturo & Erika Escobar
Phone:
(701 )367 -2927
Email Address
Mailing Address
416 3RD St NW
Sabin MN 56580 4142
8/20/2018,2:40 PM ,1 of3
https://onegov.co.ottertail.mn.us/view.php?id=3822&viewOnly=l&p=Land,& Resource Permit Applications
Property Information
Property
Please
search by
one of the
following:
Parcel #,
name, or
Physical
Address.
Click the blue
"Select" to
select
Selected:
Primary NameProperty Attributes Property Address Legal Description
Primary AddParcei #Property Address City Legai Description Legai Description Legai Description Name
416 3RD SThARTURO
& ERIKA
ESCOBAR
37000320180001 23644 STATE
HWY 108
PELICAN
RAPIDS
UndevelopedIs the
property
De\eloped or
Undeveloped?
ShorelandIs the
property
located in the
Shoreland or
Non-
Shoreland
area?
Shoreland Information
Associated Lakes :Selected:
Lake Class LR CDLake Name DNR ID
GDLida 747 56-747
Bluff: No
Project Information
Type of Installation:Residential - New
Design Flow:1 to 2,499 Gallons Per Day
Type II
Gravity
System Type:
Eiluent Distirbution:
System Components
Type II Components:Holding Tank (Contract Required)
Depth of Well:TBI Feet
Number of Bedrooms:5
NoAbatement:
Garbage Disposal:No
Ejector
Number of Tanks:5
/
Number of Lifts:0
Number of Soil Treatment
Areas:
0
Septic/Holdlnq Tankfs)
Total Capacity of
Septic/Holding Tank(s):
1500 Gallons
Setback to Nearest Well:TBI Feet
Setback to Ordinary High
Water Level:
100 Feet
Setback to Bluff:na Feet
Setback to Dwelling:10 Feet
na FeetSetback to Non-Dwelling:
Setback to Nearest Lot Line: 10 Feet
Setback to Road Right-of- m Feet
Way:
Documentation
File 1: ^Attach Supporting
Documentation:Escobar_sewer_units_1 -5. pdf
Applicant Approyal
Applicant Signature: Seifert, Ross, W
Date Signed:08/20/2018
Please check to approve:I understand that checking this box constitutes a legal signature
1Attention:Michelle
Terms i
8/20/2018,2:40 PM ;2 of 3
I
https://onegov.co.ottertail.mn.us/view.php?id=3822&viewOnly= 1 &p=Land,& Resoiirce Permit Applications
Agreement
TTie undersigned hereby makes application for permit to install, alter, repair or extend Sewage Treatment System herein specified, agreeing to do all such
work in strict accordance with Sanitation Code of Otter Tail County. Minnesota.
Applicant agrees that the Attached Documentation submitted herewith and which is approved by a Land & Resource Management Official shall become a
part of the permit.
Applicant Further agrees that no part of the system shall be covered until it has been inspected and approved for use.
It shall be the responsibility of the applicant for the permit to notify Land & Resource Management that the installation is ready for inspection.
Note
Once a permit is approved it is velid for a period of twelve (12) months from the date of approval unless otherwise indicated on permit.
A sewer pemit does not include the building sewer (sewer line).
nvoice 08/20/2018
Quantity TotalChargeCost
$175.00$175.00 X 1Sewage System Permit • Licensed Installer added 08/20/2018 2:37 PM
Grand Total
$175.00Total (Paid)
Approvals
SignatureApproval
Brittany A. Walters - 08/20/2018 12:02 PM
9264cf03ca70dbl9039fba8fecdd898b
f92df94b2298dded4f0c493a06413e73
#1 Received and Assigned
Michelle Jevne - 08/20/2018 2:37 PM
9bdbe612432c418abel5ab43d80364ba
8 78836 918a7557fcl507da3 9283 66f,6 5
Michelle Jevae - 08/20/2018 2:38 PM
1864561beffa30d6bfl480f218110118
147cbea04c69e2a0026b8e44fd7e8818
#2 Application Review
#3 Application Approval
!,
8/20/2018,2:40 PM3 of 3
1
ORCHNARY HH
OF NORTH
BY ELEVATt
I4'53*E 421.0^
'.5<.
s 1
ORDtHART men HATER LINE
OF SOUTH UDA LAKE
BY ELEVATION ON I2/S07