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HomeMy WebLinkAboutOld Town Camp & Resort_10000120082002_Shoreland Permits_WHITE - Office GOLDENHOD - Inspector YELLOW - Owner (after issue) PINK - Assessor APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. SECTION TWP NO.RANGE TWP NAMELAKE / RIVER NO.LAKE/RIVER NAME LAKE/RI^R £ HJCTT (3a I 040 I dl4L^rq.l/lO.5^-AS?THC^/ / PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) 0 000 15,00^^0^/^Sc>/ *cj^ ^ALDESCR^TIO^ -t'OFSL^.'^OFt^jLep. CL0 4V\ y\XO dOK Gt_ 5 ^ TO gC-. ' -^0' lO dGG ^ B______________________ Daytime Phone No.Last Name First Initial Mailing Address 6LASK£>6USK» 6. _____taJjj 4^v0/4^ OLD TPLOlOT^y^L- Uv\iO SZ=>SJV Property Owner Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriatenun^r) I ONSITE WATER SUPPLY(2)Add’ntoDwelling ^Individual AWA^ ( ) None (5)RCU/Year________ ( 6 ) Attached/ Detached /V /VrVVl dd'n To Non-Dwelling (8) Storage Structure (9J W£.A.S. NOTE: MN Rules Chpt. 4725 (MN Well lon-Conf. Replacement (identily)" **• Kg Code) requires a 3' (minimum) structure (11) Other (identify)_____________ setback to a well. (12) Deck____________________ ONSITE SEWAGE TREATMENT ^^^WfWMD 'Must have Sewage System Approval ‘ from OTWMD prior to issuing Site Permit. {1 ) New Dwelling (4 ) MHA’R_____Permit No.(^d Contact Rome Mann at 218-864-5533 "Existing Non-Conf. Structure Verified by L&R‘Removal of Existing Dwelling Verified by L&R Inspector's lnitialA)ate Inspector's Initial/Date CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Outside Dimension Sq. Ftr^S^^ Setback to Lotline CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Diiftension OutsicK. DimensiolA > Ft. X 3 3 Ft. & Ft."'7% iFf^* Ft. X Ft."Ft."Ft. X Ft.*:, Sq. Ft. \______ Setback to Dsjline___ ^^'Setbackto Rigm^Way j ^ ^/Setback to Ordinary N(gh Water L^l __ Elevation Above Ordinar^igh ^ter Level Setback to Septic Tank Setback to Orainfield Sq. Ft. \ Setback to Lotlin^ Setback to Right of Setback to Ordinary HighW^ Level __ Elevation Above Ordinary^mgl^Water Level Setback to Septic Tan Setback to DraInfMo Setback to Blptf_______ Maximum^oposed Height ( ) Bpathouse ( )<Gazebo **Project/Lotllnes/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft.&Ft."Ft.Ft.**Setback to Right of Way Setback to Ordinary High Water Level Elevation Above Ordinary Hjgh Water Level _ Setback to Septic Tank / ^ Ft^ ^ Setback to Drainfield ^--3 Setback to Bluff ->5^ Ft / Total Bedrooms 5,. \/^ I Maximum Proposed Height /3 F Root Change ( Ft." Ft.Ft. Ft. Ft.Ft. Setback to Bluff / Maximum Propospo Height Roof Change/r(^ ) Yes ( ) No BathroonyProposed ( ) Yes ( ) No Ft.Ft. F^ iX5)No ^ Ft: Basement ( Walkout Basement ( ) Yes (side profile required) ( ^ No ( ) Screen Porch ( ) Storage Structure Topographical Alteration / Earthmovinq □ None * Must Include on scale drawing, additional Permit may be required.20 Cubic Yards or Less *□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More* CHARACTERISTICS OF LOT: C-Ft Bluff (X ) Yes ( ) NoSq. Ft.Lot Area Water Frontage Total Lot Area (FTz) Impervious Surface Ratio:X 100 =,%Total Impervious Surface Onsite (FT')Impervious 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 con­ dition 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 & Resou inagem^offjpe'opee the buiiding footings have been constructed. Date: Signature of Proper! Date: Land <S Resource K^agement Officii PERMIT FEE $PROJECJ(S) TOTAL SQ. FT.______________________________________________RECEIPT NO. Date Stamp uHihJiulj odb OMJtfjj dialp L&R Initial Form No. BK — 07-2011-05 347.648 • Victor Lundeen Co.. Printers • Fergus Fells. Mlnnesote - f APPLICATION FOR SITE PERMITWHITE-Cffice * GOLDENnom Inspector YElIoW - Owner (after issue) PINK - Assessor LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAk GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 \{-ecL' '• 218-998-8095 www.co.otter-tail.mn.us w -? jos- T RANGE TWPNAME cA, O S' O cj r (X-i ! APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. SECTION TWP NO.LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVJ CLASSi""I(sT'c^-’i 'S ITHC//>y /_ PROPERTY (E-911) ADDRESSPARCEL NUMBER (S) 1 OOOO I ^o LEGAL DESCRIPTION ~ 7 7 , /. ly, ' (-?>+ < u T= SL &'t 6P cP ‘^‘01^ rju2 doK Qt- ^ ^ ^ g CL- C> g i:r___________________________________! i FirstLast Name Initial Mailing Address Daytime Phone No. bLA^KOi^Kt b. 4b -T-b/b^ Property Owner TI’O OLO TDt-<JiOTlPjA-t L ^Lri~Hi^ie/ALc. Contractor Name Lie.# PROPOSED PROJECT (please circle the appropriate npml^r) (1 ) New Dwelling (2 ) Add'n to Dwelling ( (4) MHA'R________ (5 ) RCU/Year (71 Add’n To Non-Dwelling (8 ) Storage Structure (9t WyD.i ^^^Non-Cont. Replacement (iderttily)*' C C< i ^ (11) Other (identify)_____________ (12 ) Deck____________________ ONSITE WATER SUPPLY ONSITE SEWAGE TREATMENT SYSTEN|_ ) Permit No. - - i 1 c^wrll ^wejj^g*'*''^ 6 ) Attached / Detached ■ y(^ Individual ^mh\( ) None NOTE: MN Rule's Chpt. 4725 (MN Well Code) requires a 3’ (minimum) structure ^ setback to a well. ./C;e.A.S._^rig©TWMD 'Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rotlie Mann at 218-864-5533 ’Removal of Existing Dwelling Verified by L&R "Exisfing Non-Conf. Structure Verified by L&R Inspectors inillal/Dale Inspector's Initial/Date CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE) Outside, Dimension, CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Diitf^nsion Sq. Ft\ Setback tobtline ' Setback to Rigbqf WayTv* 'Setback to Ordinary H|gh Water Lev6l __ Elevation Above Ordina'ry-High Water Level Setback to Septic Tank__ T J Setback to Drainfield / ' Setback to Bluff y Maximum Proposal Height / Roof Change..^ ) Yes ( ) No Bafhroom Proposed ( ) Yes ( ) No Ft. XFt. X - 5 Ft.**/Outside Dimension__Ft. X Sq. Ft.-^—-^-0 Setback to Lotline 4 /■ Sq. Ft. Setback to Lotline Setback to Right of Way / Setback to Ordinary High^W^b^-evei *' Elevation Above Ordinary, Water Level Setback to Septic Taijlf'__ \ Ft. Setback to DrainfielS____ / Setback to Blplt________ Maximum Proposed Height / ( ) B^thouse ( jlSazebo Prior to Application / Inspection \Ft. &Ft.&___/Ft.**\Setback to Right of Way J t> -Ft.** Setback to Ordinary High Water Level __ Elevation Above Ordinary High Water Level ,■*-> Setback to Septic Tank *' FL / ,• Setback to Drainfieid Ft/ Setback to Bluff Ft. \ Ft.**Ft. 9^ Ft.Ft.** Ft.Ft.-'Ft. Ft. __y bL. Total Bedrooms y' ( '■ Maximum Proposed Height / ^ Ffs-— - ( '[) Ft. Ft.Ft. I(^No or) No Ft>Roof Change ( Basement ( Walkout Basement ( ) Yes (side profile required) ( No i( ) Screen Porch ( ) Storage Structure I'1**Proiect/Lotti|^es/Right-of-ways Must be Staked Onsite Topographical Alteration / Earthmoving /i-iC ,3* Must include on scale drawing, additional Permit may be required.1 Q 20 Cubic Yards or Less *□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More*□ None CHARACTERISTICS OF LOT:fi ^ 9 Ft. Total Lot Area (FTh Bluff (Y )Yes ( )No__Sq. Ft. Water FrontageLot Area, I Impervious Surface Ratio:X100 =.% Total Impervious Surface Onsite (FT!)Impervious 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 shaii 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 con­ dition 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.rstand that it is my responsibiiity to inform the Land & Resource Management office once the buiiding footings have been constructed.lu / 6-/ / ^/ Date: Signature of Property Owner / Agent for Owner // !'( : h Hi '"r/C LI 1:.Date: Land & Resource Management Offig^ rs.o'Q hlPROJECT(S) TOTAL SQ.FT.,PERMIT FEE $RECEIPT NO. 'pdomments: A/' //Zy* I'/l iui <f (/.Y f -//' 7,7- , 1^. Y r i‘ f ft fJ I ' * ^ /: fA ZC ‘-A '(.j U • ' U) ■' ■ J 7f f l/d ‘I'fy!:• 1 1 !ikCJf. il .'T t/j, ^hfTi />IX i r /•r'.'' /,• -- V y : • i'■A. ■' / ■ '' i Form No. BK — 07-2011-05 347,648 • Victor Lundeen Co., Printers • Fergus Falls, Minnesota «iT SITE PERMIT INSPECTION RESULTS Inspector must make all measurements and computations Ft.Structure Set Back from Ordinary High Water Level Ft. Ft. Ft.Structure Set Back from Top of Bluff Ft.Structure Set Back from Road Right of Way Ft. Ft. & 100'*'Ft.Ft.&Ft.Structure Set Back from Lot Lines Ft.Ft.Structure Height f /O’*Ft.Structure Set Back from Septic Tank Ft. Ft.Structure Set Back from Drainfield Ft. Elevation Of Lowest Floor Above Ordinary High Water Level____________________5^Ft. Ft. Land Slope at Building Site %% Inspector’s Comments / Sketch: / 10^ I 9 ^7<(■ •> 0 Inspector's Signature IT)'15-1^ DategTInspection Time of Inspection J^Project Approved Date / Initial / . /'V/ M.I i % .S-^ C /1 ^ijjp {'3>Z •» / ' ; Uo A+ <1 /’ \>/j>^1 »V-6- ! OlO ~rc?u;(0 "^&So)Q /! '(if:] i » ’ * t■! ?l('! I «') 1'^ )y^'■\ d3ckAM^;\ a.4- ■^«:i:kcA' Vj-i:ovAi^ (y\y^^^bu Ic?*TG V.^• tI-1-"^ U^e-ep ^ e« :.6V lOl^ * N■E~lj r '••1' r t-prPp3 -i.'i i IJ /,<; ‘ *V'-i/ ! ' U 1i A *1r1,/1 >-■ r IIJL’-^ j. .,.,lf i I ^ VKi (XK\fIJi ~ 15 -Tfc'.-Ii VVli'lWit fi.'fe tP" i^O usf k r-1 f ^ \r;i I ^L • Viaof Ljndeen Co . Pfinters • Fergus Falls. MN • l-BOO-346-4870MKL — 0071 — 029MKL —0871 —029 281.949 • Viaof LuntJeen Co. PrtniefS • Fergus Falls MN • 1-BOO-346-4070 281.949 IMPERVIOUS SURFACE CALCULATION WORKSHEET:A •I « .List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing): Ft^ /Structure(s):/ Ft2Deck(s): 11.167 Ft2Driveway(s): 1 7 received SEP 1 0 2012 lands RESOURCE Patio(s): Sidewalk(s): 7Z Ft2Stairway(s): Ft2Retaining Wall(s): Ft2Landscaping: (Plastic Barrier) Other:^QC> Ft2 .3 Ft2 R2 7,0.^ TOTAL IMPERVIOUS SURFACE: LOT AREA: %X 100 IMPERVIOUS SURFACE RATIOLOT AREATOTAL IMPERVIOUS SURFACE WHITE - Office, GOLDENROD*" Inspector APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT, COUNTY OF OTTER TAIL GOVERNMENT SERVICES CENTER, 540 WEST FIR, FERGUS FALLS, MN 56537 218-998-8095 www.co.otter-tail.mn.us YELLOW - Owner (after Issue) PINK - Assessor Permit No.APPLICATION MUST BE COMPLETED IN ORDER TO BE PROCESSED. RANGE TWP NAMETWP NO.LAKE/RI CLASS SECTIONLAKE/RIVER NAMELAKE / RIVER NO. (35 I 01-0 I d',4L^rq.lilO.K PROPERTY (E-911) ADDRESSPARCEL NUMBER (S)7^^/ Cr4U.j/m ^OOOO I .2,00 ^ALDESCR^TIO^ -fe- OF SL & 0 OL ^ WUJ dOK G«- 3. S. I -^o' 10 pec, g 3ig.Aq' E (E Daytime Phone No.Initial Mailing AddressFirstLast Name 'MlkRpj _____ 8LAsK0i<.&Ki onfrtl.'A 6.old TOLQIQT^AiProperty Owner ctL\THOlyALC S^SJy ________^juA> Contractor Name Lie.#■A PROPOSED PROJECT (please circle the appropriateruj^r) ONSITE WATER SUPPLY (1 ) New Dwelling (2 ) Add'n to Dwelling ^ ^ (4)Ji^K(YR________ (5)RCU/Year________ ( 6 ) Attached / Detached (T VAdd'n To Non-Dwelling (8) Storage Structure {W£.A.S. ^ £ ^I’^Non-Conf. Replacement (identify)" C vp ____________ ft 1 (1 ^^ther (identify)s((12n5i<, ONSITE SEWAGE TREATMENT SYSpi^g^ I( ) None lOTE: MN Rule( Chpt. 4725 (MN Well ode) requires a 3’ (minimum) structure , setback to a well. ) Individual Permit No. #rWMD "Must have Sewage System Approval from OTWMD prior to issuing Site Permit. Contact Rollie Mann at 218-864-5533 "Existing Non-Conl. Structure Verified by L&R'Removal ot Existing Dwelling Verified by L&R Inspector's Initial/DateInspector's Inittal/Date CHARACTERISTICS OF PROPOSED W.O.A.S. (WATER ORIENTED ACCESSORY STRUCTURE)CHARACTERISTICS OF PROPOSED NON-DWELLING Outside Diiftension CHARACTERISTICS OF PROPOSED DWELLING (Must Include Attached Garage) Outside Dimension ___Ft. x 3 3 Setback to Lotline ^ ^ *— / 0 Ft." '' Setback to Right of Way 7 ^Setback to RiohKif Wav T? SeteCTMgh Water Level/ Ft. f *^ESS;;Wr;ary High Water-U^ZT^ Outside DimensimFt. X Ft."Ft.*yFt. X Sq. Ft. \ Setback to Dslline Sq. Ft. \ Setback to Lotting Setback to Right of Setback to Ordinary High^<(^ Level __ Elevation Above Ordinarj^^Water Level Setback to Septic TanJ Setback to Drainfj/rfd. Setback to Bluff Ft."Ft.&Ft."Ft.&, Ft." Ft.h Water Le^l __ Elevation Above Ordinar^igh ^ter Level Setback to Septic Tank__ Setback to Drainfield / Setback to Bluff / Maximum PropospQ Height Roof Change/t ) Yes ( ) No Bathroora/Proposed ( ) Yes ( ) No Ft.1%Ft.,/'Ft. Setback to Septic Tank Setback to Drainfield Setback to Bluff Total Bedrooms Ft. !IU “pSTf ^ serjeZ-^ Ft.Ft. Ft./B^Ft. (/fNo ^ tX5)No Ft. Maximum Proposed Height Roof Change ( Basement ( Walkout Basement ( ) Yes (side proiite required) ( yC) No F^ Maximum^roposed Height ( ) s/house ( )<Gazebo "Project/Lotliries/Right-of-ways Must be Staked Onsite Prior to Application / Inspection Ft: ( ) Screen Porch ( ) Storage Structure iiiirje: * Must include on scale drawing, additional Permit may be required. Topographical Alteration / Earthmovino □ None CHARACTERISTICS OF LOT: C- A<LA(^'S> 20 Cubic Yards or Less *□ 300 Cubic Yards or More*□ 21 Cubic Yards ■ 299 Cubic Yards* ££5Lfi.Bluff (X ) Yes ( ) NoSq. Ft.Water FrontageLot Area 30/65'7 , ?jc=,c>n Total Lot Area (FT?)X100 =%Impervious Surface Ratio; _Impervious Surface RatioTotal Impervious Surface Onsite (FTO 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 con­ dition 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 & Resouri nagemei^offipe’o^ the building footings have been constructed. Date; Signature of Property Owner / Agent for Owner- Date; K^a^meniOffigaL PROJECJ(S) TOTAL SQ.FT. ____ PERMIT FEE ^ __ OkMjiduo tjj-UO iptn>idjO Land & Resource RECEIPT NO. Date Stamp /yj 9M/Z I ».Q Initial IMPERVIOUS SURFACE CALCULATION WORKSHEET: List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scaLe^^raMlig): - -fS;Ft2Structure(s): Ft2Deck(s): 11.1 C^7 Fp 17 ■^4.^ F|2 Driveway(s); received SEP 1 0 2012 land & resource Patio(s); £ S'Sidewalk(s): Rstj. 7Z FPStainway(s): Ft2Retaining Wall(s); Ft2Landscaping: (Plastic Barrier) Other:JK^SO Ff2 ?, O. 6^Ft2TOTAL IMPERVIOUS SURFACE:/ FPLOT AREA: X 100 =.% IMPERVIOUS SURFACE RATIOTOTAL IMPERVIOUS SURFACE LOT AREA ! I I I • J •f' f / 1\ o I \1 T ' ''^ 3 4KT*y "- ' '' fci .'*•»* / i~n ^7t i .r-- C'-i -‘C... -S' -y .f' ^7 ■■ t>-:^. '.^v •l^ t Cr::^ •'i- ', ' •-■; •> iK 5 liCj c 7 \i " i;i'TWf ' Uo hi7 /41/ (<&-1<^-I!: :1 OUO ~TZyu;hJ -k^eSo^l Ck./V 5 ?l / in %!• t j \J - (a^ /I ■"■(2?Uvyv4>\'ViOl^ tr Ue-ep ^ l^^/^V'ioi^ , CL- {y\M'ujbU 'v ■ i//i'/-,V / /a '6: Y'^A L .VV'fclJoi -■> Cl-W\t9 ^ !W«fr' ~ i>.!>'iC.h A C.-C0 i-s- •-:■3V /, /l/' 7—'A _AvJs-f/fjA A pitfC i i rIf'-<x I i;It _____!A■: i'J':-Ss. 1 A if ^'' I :t- 9 ^ A i irkXyA c4 Moi>h'Tlj * -* A\43t>, ' ^ 1 IIL/I \v'!UA » ^Ik:![hI!\IU)<4 !> O U A'?A''^'Sio i" -f»■ i A■’ f '^Ol 1 .^t:o-9 <—4 V c'_ 41 5i I ,MOUvJ LiAl *rr iAd usS^ -f—t I’h'f H %■ It 'Z5^3i f f{I0iO/Mi ■ //Uci^k-^1 1 \Mr I\M -Au<^r ",■1i } • VKHot Li>ndeen Co. Pflni«s • Fergus Fells. MN • '-SOO-346-4870 _^MKL — 0871 — 029MKL — 0871 — 029 2ei.S49 • ^cior LunOeen Co.. PriniefS • Fergus Fells. MN ■ 1-800-346-^670 28V949 LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE Phone:(218) 739-2271 • FERGUS FALLS, MN 56537 APPLICATION FOR SITE PERMITWHITE ■ Office GOLDENROD - Inspector YELLOW - Owner PINK - Assessor Permit No.Pi. GrlLEGAL DESCRIPTION BLUFF ZONEAND□ YES [gi NO LOCATION TWP NAMESECTIONTWP NO.RANGELAKE/RIVER NAME LAKE/RIVER CLASSLAKE NUMBER Cl, M ccI/O I Cl, TOPOGRAPHICAL ALTERATION □ YES # OF CUBIC YARDS FIRE NUMBERPARCEL NUMBER (S) ooo-j:i-oos-;>-oc X NO TELEPHONE NO.IDENTIFICATION: Please Print All Information Mailing Address — No. Street, City, State, and Zip Code (Daytime)First InitiaiLast NamerLdifLii-r<> ^ J^cl/ - fcC^Li ^ c />? /^, '5~6 r >y Property Owner 7LPNameContractor State Lie. # ONSITE WATER SUPPLY ( ) Individual Public ( ) None ONSITE SEWAGE TREATMENT SYSTEM . ^)^ndividual Permit # O' ^ ( ) Collector Permit It______ ( )OTLSD PROPOSED USE ( ) Dwelling ^^on-Dwelling ( ) Water Oriented Accessory Structure (WOAS) PROPOSED PROJECT ( ) New Struclure(s) (yCAddition(s) ( ) MH/RV______________YEAR CHARACTERISTICS OF WOASCHARACTERISTICS OF NON-DWELL|NG ( ) Utility Structure HARACTERISTICS OF DWELLING ^ Garage ( ) Screen Porch( ) Boathouse( >Qwelling ( ) Adoftiqn to Dwelling ( ) BasemenN. ( ) Walkout Bab«(nent Outside Dimension ( ) Utility Structure( ) Gazebo( ) Other Outside Dimension ,2a ( ) Other Outside Dimension Ft. X P Ft..Ft. &Ft.Lolline SetbacksLX Ft. X Ft.Ft.Lotline Setbacks Ft.OHWL Setback Ft.Ft.&Lolline Setbacks ( X)NoOHWL Setback .Ft.Bathroom:( )Yes (If Yes / a complying Sewage System Required)Ft.OHWk^etback Total Bedrooms /C Diaximum Height /10 ft. (1 story)Maximum Height / 35 Ft. (2 story)Maximum Height Ft. z Sq. Ft. Impervious Surface Ratio .%Sq. Ft. Impervious SurfaceLot Area 3 Ft, (3' minimum)Ft. Elevation of lowest floor above OHWLWater Frontage u2o .%Ft. Slope of lotStructure setback to right-of-way ) o Ft. (10’minimum) (Sewage System Permit required before installation).Structure setback to septic tank Ft. (20'minimum) (Sewage System Permit required before installation).Dwelling setback to Soil Absorption System___ Non dwelling setback to Soil Absorption System JO Ft. (10'minimum) (Sewage System Permit required before installation). 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 & Resource Management office once the building footings have been constructed. Dated: Signature of Owner Dated: Land & Resource Management Office RECEIPT NO.PERMIT FEE $ Comments: Form No. BK — 0597-002 266.110 • V.:ig: u.njeen Co Prinieis • Fergus Fd- s Mf. •■ -SuO-j-o-'^aTi LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone:(218) 739-2271 • FERGUS FALLS, MhP APPLICATION FOR SITE PERMITWHITE-Office GOLDENROD - Inspector YELLOW ■ Owner PINK - Assessor 7 0^fPermit No.aHLEGAL DESCRIPTION ,Gl ^0 BLUFF ZONE/AND □ YES 13 NO LOCATION TWP NAMESECTIONTWP NO,RANGELAKE/RIVER CLASSLAKE/RIVER NAMELAKE NUMBER cc/ 3.^Cl. LC Cv I a FIRE NUMBERTOPOGRAPHICAL ALTERATION □ YES # OF CUBIC YARDS 'ta NO PARCEL NUMBER (S) IDENTIFICATION: Please Print All Information TELEPHONE NO. (Daytime)Mailing Address — No. Street. City, State, and Zip CodeFirstInitialLast Name !' la fui LU-Ti. id o A _________}gc kl - fct'- ( .Property Owner t Aj t T9.^ LfNameContractor i 1State Lie. # ONSITE WATER SUPPLY ( ) Individual Public ( ) None ONSITE SEWAGE TREATMENT SYSTEM . (^Individual Permit # 5 / (2^* ( ) Collector Permit #______ ( )OTLSD PROPOSED PROJECT ( ) New Structure(s) C ) Addition(s) ( )MH/RV______________ PROPOSED USE ( ) 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 Outside O Dimension : J j ( ) Utility Structure( ) Gazebo -1( ) Other Outside Dimension ■ '4 Ft. X .Ft.( ) Other, Outside Dimension 1 ^^Ft. .Ft.Lotline Setbacks Ft.&Lx .R.Ft. X Lotline Setbacks .Ft..Ft,OHWL Setback Ft. .Ft.&.Ft.Lotline Setbacks .Ft.Bathroom: ( ) Yes ( (If Yes / a complying Sewage System Required) OHWL Setback .Ft.OHWL Setback Total Bedrooms Maximum Height / 10 ft. (1 story)Maximum Height / 35 Ft. (2 story)Maximum Height Ft. / (j ,Sq. Ft. Impervious Surface Ratio .%I O .Sq. Ft. Impervious SurfaceLot Area y 3 Ft. (3’ minimum).Ft. Elevation of lowest floor above OHWLWater Frontage Ft. Slope of lot .%Structure setback to right-of-way ) O .Ft. (10’minimum) (Sewage System Permit required before installation).Structure setback to septic tank Ft. (20'minimum) (Sewage System Permit required before installation).Dwelling setback to Soil Absorption System 111 Ft. (10'minimum) (Sewage System Permit required before installation).Non dwelling setback to Soil Absorption System TH/S 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 expresf 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. </i!~ooDated: Signature of Owner \ Dated: Land S Resource Management Office RECEIPT NO. ' 7^ & 1PERMIT FEE $ \Comments: i i j V-.]*T ■•1 1 \■fT T Form No. BK — 0597-002 • ViClfl./ Co.. Ptiniftts,.? f.ArgwS Fa-s MN • '-aOC-SJo-^BTf ...i < -' : 5'j- INSPECTION RESULTS Make all measurements and computations /rrs-hStructure Set Back from Ordinary High Water Level Ft.Ft. Ft.Ft.Structure set Back from Top of Bluff Ft.Ft.Structure Set Back from Road Right of Way JU^^FX. & Ft.Ft.Ft.&Structure set Back from Lot Lines Ft. Ft.Structure Height 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:, \ -i JO iPti v«- Inspector's Signature Date of Inspection imTime of Inspection , 19Dated;Please sketch your lot indicating setback^om road right-of-way. lake, sic eyard and septic tank and drain- field for each building currently on lot am any pfoposed structures. Signature Please sketch your lot indicating setbacks from road right-of-way, lake, sideyard and septic tank and drain- field for each building cunently on lot and any proposed structures.< y t i __. v»^;I ■!. f r * iI Ii -o^ I / ..^ 3^0' .y -■ *•'I 3:I I f,c3LDfi i. ^ \ ■ ’.=■V *Tl5 uofO■i- Kn X t, ■■, ^I 5 IS|- ;J V.. ]\\ V Cii ! ■i. i ' r * -• ■»■*< {\{ o-::> 'S''1 V.. /P fx U \ ■5V ■ i i V»■■ I rh !■ I yi/i-Iti\y \ -'i 044wL I? I( ^ I