HomeMy WebLinkAboutOttertail Beach Resort_46000990202000_Shoreland Permits_WHlfE~-Office
GOLDENROD - 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
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKE/RIVER NAMELAKE / RIVER NO.LAKE/RIVER
CLASS
SECTION TWP NO,RANGE TWP NAME
Slp'SHl iQTTge^ 7/)iO
PARCEL NUMBER (S)
440C»<^‘J0^^3^Da0 ^%Z£j'WC>
LEGAL DESCRIPTION * J ^
i<yt I I 4»I0 4oT Z-| 04D6C-Z-
31 I 134 I 03*1 I OTTEiiaMlO
PROPERTY (E-911) ADDRESS *7”^ 7M
Last Name First Initial Mailing Address Daytime Phone No.7,ni^< aI. PA-(i^{C. lOo,A/j/l05oj i>coTir PProperty
Owner Dmf' A.hf\f^D5^rl
Oir-eL' Tf^lL EB4cU'/
Contractor
Name
Lie.#4. 5I0Z
.PROPOSED PROJECT (please circle the appropriate number)
(1 ) New Dwelling
(4) MHA'R____
ONSITE WATER SUPPLY
(^Individual ( ) Public ( ) None
NOTE:' MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM(2) Add'n to Dwelling
(5) RCUA'ear_____(6) Attached / Detached Garage ( ) Permit No.
J^i^OTWMD 'Must have Sewage System Approval
from OTWMD prior to issuing Site Permit.
Contact Roltie Mann at 218-864-5533
(T^dd’n To Non-Dwelling (8) Storage Structure (9) W.O.A.S. ^ ^J^Non-Conf. Replacement ridentifvt _________
^^2AjCTl6v| lo/zZ/A(11) other (identify)______
‘Existing Dwelling to be removed prior to lil^^OF ^“^^^DW.O.A.S.
CHARACTE
^ATER ORIENTED ACCESSORY STRUCTl,|WE)OutW
DimetiWin
CHARACTERISTICS OF PROPOSED DWELLING
(Must Include Attached Garage) t fj
Outside Dimension ^ 8 Ft. x Zp
Sq. Ft./^1S5-
Setback to Lotline _______________________
Setback to Right of Way Ft."
. Setback to Ordinary High Water Level / / Q Ft.
Elevation Above Ordinary High Water Level
Setback to Septic Tank / Q Ft.
Setback to Drainfield f 0 Q Ft.
Setback to Bluff AI/)-
Total Bedrooms "iJ
Maximum Proposed Height y /
Roof Change (}^Yes ( ) No
Basement ^^Yes ( ) No
Walkout Basement ( ) Yes (side profile reguirep) ^^No
QHARACTERISTICS OF PROPOSED NON-DWEI,LINGOul&de
Dim^ion Ft. X Ft."Ft."Ft. X Ft.”
Sq. Ft. \
Setback to Mline____
Setback to Ri^of Way
Setback to Ordinate High Water^el __
Elevation Above OrdiNary Hig^nVater Level
Setback to Septic Tank \/
Setback to Drainfield /
Setback to Bluff /
Maximum ProfMMd Height
RoofChano/( )Yes ( ) No \
Bathroon/Proposed ( ) Yes ( ) No
^3 Sq. Ft. \
Setback to Lohine ___
Setback to RighiVway
Setback to Ordinary l^h Watet/Cevel __
Elevation Above OrdinaryHij^ Water Level
Setback to Septic Tank
Setback to DrainfieldiC
Setback to Blufy^
Maximum Pjdposed Height
( ) Bo^ouse
( )JSazebo
**Project/Lotlines/Rlght-of-ways Must be Staked Onsite Prior to Application / Inspection
Ft.&Ft.”Ft.&Ft."Ft.&Ft.”
T,"Ft."
Ft.Ft.Ft.
Ft.
Ft.Ft.
Ft.Ft.Ft.
Ffin Ft.Ft.Ft.Ft.
( ) Screen PorcliV
( ) Storage Structu
Topographical Alteration / Earthmovinq
□ None ^ 20 Cubic Yards or Less *
CHARACTERISTICS OF LOT:
* Must include on scale drawing,,
additional Permit may be required.□ 21 Cubic Yards - 299 Cubic Yards*□ 300 Cubic Yards or More*
tC^<r"5~J __Ft ( )VesSq. Ft.Lot Area.Water Frontage Bluff No
O.Zai 30-755'4
Total Impervious Sunace Onsite (FT^)sImpervious Surface Ratio:X 100 =-4 .%
Total Lot Area (FT^)Impervious Surface Ratio
5 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 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 & Resource Manaoement office once the buiiding footings have been constructed.
UM9(A-Ik'3
\ \,C>
Date;4,
Sigr^ture otProperty Owner / Agent for Owner
0Date:
-------------------------------7---------------------
RECEIPT NO.
Land StV^esource Management Office
PROJECT(S) TOTAL SQ. FT.PERMIT FEE $ yiS>
una a ________________
fiXPt/KErteuT iOUBcufJC Lof/Lu 0£cA£Ast imA. /^/>» J/,3
pO f LaT-Li^£ ^/TAAoL 'tO
Comments:
Form No. BK — 1003-0407 329,582 • Victor Lundeen Co., Printers • Fergus Falls. Minnesota
T7-
APPLICATION FOR SITE PERMIWHITE - Office '
GOLDENROD - Inspector
YELLOW - Owner (after issue)
PINK - Assessor
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
PLEASE PRINT OR TYPE ALL INFORMATION Permit No.
LAKE / RIVER NO.LAKE/RIVER NAME LAKE/RIVER
CLASS
SECTION TWPNO.RANGE TWP NAME
■ • / CT' .,
A/31 KM I 03q IPROPERTY (E-911) ADDRESS *7””^ 76/J
PARCEL NUMBER (S)
^coao'^'^ozazoao qMiZo'ttX)
LEGAL DESCRIPTION J
^0*1 I
Last Name First Initial Mailing Address Daytime Phone No.
M/^osoJ Pgnf A~~ 174 37/r /.4?icc ^4/
^6^-3 'Property
Owner
Contractor
Name
Lie.#4- 5lOc
PROPOSED PROJECT (please circle the appropriate number)
(2 ) Add’n to Dwelling
(5) RCU/Year______
{JJ Add’n To Non-Dwelling (8) Storage Structure
10J.-I^on-Conf. Replacement (identitvl (s € S (.r i-£-61 ^: a (i<iJ
7i 1 ) Other (identify)_____________________________________^______
’Existing Dwelling to be removed prior to >ni -,!. uC i iC ______
ONSITE WATER SUPPLY
( ) Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM(1) New Dwelling
(4) MH/YR_____
(8) ’Replacement Dwellirtg
(6) Attached / Detached Garage
(9) W.O.A.S.
( ) Permit No.
Q.i)’0TWMD 'Must have Sewage System Approval
^ from OTWMD prior to issuing Site Permit.
Contact Rollie Mann at 218-864-5533
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
Dimension
Sq.Ft.A,^
Setback to Lotline ___
Setback to Right of Way ______y/Tt“
Setback to Ordinary High Water Level __
Elevation Above Ordihary HigtTWater Level
Setback to Septic Tank^y^ Ft.
Setback to Drainfield /
Setback to Bluff /
Maximum Proposed Height
Roof Change ( ) Yes ( ) No \
Bathroom Proposed ( )Yes ( )No'
■,
./Ft. X Ft.”Outside Dimension
Sq. Ft. j. ;
Setback to Lotline
Setback to Right of Way ^ > Ft.”
Setback to Ordinary High Water Level i j O Ft.
Elevation Above Ordinary High Water Level Ft.
Setback to Septic Tank > iJ Ft.
Setback to Drainfield i O Ft.
Setback to Bluff "K'4 Ft.
Total Bedrooms
Maximum Proposed Height 3 / R-
Roof Change ( >) Yes ( ) No
Basement (' .--tf Yes ( ) No
Walkout Basement ( ) Yes (side prolite required) ( .) No
Ft. X 3 Ft.”Ft.” /Ft. X
41 Sq.Ft.
Setback to Lotline ___
Setback to Right 6f Way
Setback to Ordinary High Water, Level __
Elevation Above Ordinary High Water Level
Setback to Septic Tank ^
Setback to Drainfield 1
Setback to Bluff
Ft.&Ft."Ft.&Ft.”Ft,&Ft."
/Ft.”
Ft.
Ft.
Ft.Ft.
Ft.
Ft.
-c Ft.
FfS
Ft.
\ Ft.Ft.
Maximum Proposed Height
( ) Boathouse
( ) Gazebo
**Project/Lotlines/Right-of-ways Must be Staked Onsite Prior to Application / Inspection
( ) Screen Porefi'v
( ) Storage Structure\
Topographical Alteration / Earthmovlnq
□ 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:
/CO.Lot Area,Sq. Ft,Water Frontage Ft.Bluff ( )Yes (;-.^)No7
30 /JImpervious Surface Ratio:Total Impervious Sui^ace Onsite (FT^)X100 =.%Total Lot Area (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 responsibility to inform the Land & Resource Management office once the building footings have been constructed.
Date:
Signature of Property Owner/Agent for Owner
r-.fDate;
Land & Resource Management Office' 3 ^^3,‘tT'r'O—...\^C\PROJECT(S) TOTAL SQ. FT.PERMIT FEE $RECEIPT NO. 1
Hl :.rc^'‘LJ irJe''L\jOL .OComments:
!
Form No. BK — 1003-0407 329,582 • Victor Lundeen Co., Printers • Fergus Falls. Minrjesota
SITE PERMIT
INSPECTION RESULTS
Inspector must make all measurements and computations
Structure Set Back from Ordinary High Water Level Ft.Ft.7r^
Structure Set Back from Top of Bluff Ft. Ft.
Structure Set Back from Road Right of Way Ft.Ft.
/O Ft. & / T Ft.Structure Set Back from Lot Lines Ft.&Ft.
Structure Height Ft.Ft.
/ 2:Structure Set Back from Septic Tank Ft. Ft.
Structure Set Back from Drainfield Ft.Ft.
Elevation Of Lowest Floor Above Ordinary
High Water Level 3*^Ft.Ft.
Land Slope at Building Site %%
Inspector’s Comments / Sketch:
ivb1!Xi
_1 3I
i
i
‘ )
!
-si
o
Inspector’s Signaturi
//.:ro
Date of Inspection
Time of Inspection
^''project Approved
Date / Initial
OTTER TAIL WATER
MANAGEMENT DISTRICT
27234 368TH AVE.
Battle Lake, MN 56515
Phone (218) 864-5533
Mr. Scott Madsen
28255 Midway Park DR N
Battle Lake MN 56515
TO: Otter Tail County Land & Management Office
Aug. 25, 2010
This letter is in reference to the septic system at p/n-460009203000 28255 Midway Park Dr. N, owned by
Scott Madsen. It was installed in 1985 per District & State codes for a 3 bed- room home. The system is
functioning properly at this time. There has been a permit taken out to move the septic tank to allow for
proper setbacks. All wells are the owners’ responsibilities.
If you have any questions please feel free to contact me. Thank you
Sincerely,
Roland R. Mann
Administrator
Memorandum
To: Otter Tail County, Land & Resources Management
From: Scott & Beth Madson. Otter Tail Beach Resort
Date: 08/30/2010 &hi/ioRe: Application for Site Permit
Attached is our application for a site permit to replace the existing owners
home/office at Otter Tail Beach Resort.
The proposed house is approximately the same footprint as our existing home
however we have modified it slightly to increase the setback from our neighbor to a
full 10 feet. In addition, the proposed house and deck will reduce the overall amount
of impervious surface by 0.6%.
The main reason we would like to replace the home rather than remodel, is that the
current foundation is in poor condition and has settled as much as 3 inches in places.
With a new foundation we will have a low basement/crawl space so that we can
psavide a storm shelter for our resort guests.
If you have any questions, please call me at 218-864-5860.
Thank you,
Scott Madson
Otter Tail Beach Resort
1
SCALE DRAWING FORM
^qozozooo ^ 46000 ‘{‘jOZ02)000
Tax Parcel Number(s)
The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/or proposed structures, septic
tanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, wells, wetlands, topographic features (i.e. bluffs), and onsite impervious surface
calculations.
l"= ZO^y^.7 %Scale Impervious Surface Ratio
(Must Complete Worksheet On Other Side)
P^oPOS^O
loo^sy'
TV
oU
x)
/^L_i
o
130'Uj
O
*-Z TJ&
o
g)^e>Hc^
d
C)
l2oof/\
V
Signature of Property Owner
shilfo
Date
BK — 0909 338.596 • Victor Lundeen Co, Printers • Fergus Falls, MN • 1-800-346-4870
IMPERVIOUS SURFACE CALCULATION WORKSHEET:
List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown on scale drawing):
Ft2Structure(s):
65~7 Ft2Deck(s):
■^o Ft2Driveway(s):
Ft2Patio(s):
5Q3 Ft2Sidewalk(s):
Ft2Stairway(s):
O Ft2Retaining Wall(s):
Ft2Landscaping:
(Plastic Barrier)
Other:£2 Ft2
id, IC>J>
Ft2TOTAL IMPERVIOUS SURFACE:
Ft2LOT AREA:
/g,/d.T m-7
IMPERVIOUS SURFACE RATIO
.%X100 =
LOT AREATOTAL IMPERVIOUS SURFACE
• :
1i
!1;r SCALE DRAWING FORM1
44033 ^‘ioZOjOCO444V3<3 •=I^Ol08Siao
Tax Parcel Number(s)
The scale drawing must be a signed drawing which includes and identifies a graphic scale (feet), all existing and/or proposed structures, septic
tanks, drainfields, lotlines, road right-of-ways, easements, OHWLs, wells, wetlands, topographic features (i.e. bluffs), and onsite impervious surface
calculations.
i
I" ' Z£>'31.3 %Scale Impervious Surface Ratio
(Must Complete Worksheet On Other Side)!I I
i
ISr/STi/i/e
;I !!I/I
100.571K:
y\j-
jII!I1
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I
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[<35£:P7«Y o I
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t>h\hOA€Z !I !Signature of Property Owner Date
1 BK — 0909 338,596 • Victor Lundeen Co . Printers • Fergus Falls, MN • 1-800346-4870IIII
IMPERVIOUS SURFACE CALCULATION WORKSHEET:
List of Onsite (Existing and Proposed) Impervious Surfaces (must be shown ^on scale drawing):
Structure(s):Ft2
FPDeck(s):
Driveway(s):
Ft2Patio(s):
‘503 Ft2Sidewalk(s):
O Ft2Stairway(s):
o Ft2Retaining Wall(s):
o Ft2Landscaping:
(Plastic Barrier)
Other:Ft2
Id, 10^
Ft2TOTAL IMPERVIOUS SURFACE:
Ft2LOT AREA:
3/^3315Id./03 .%X 100 ==
IMPERVIOUS SURFACE RATIOLOT AREATOTAL IMPERVIOUS SURFACE
APPLICATIORB FOR SITE PERIVII?
LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
Phone:(218)739-2271 • FERGUS FALLS, MN 56537
WHITE ■ Office
GOLDENROD - Inspector
YELLOW - Owner
PINK - Assessor
/5vnPermit No.I^cTS 4^)LEGAL
DESCRIPTION
BLUFF ZONEAND
□ YESLOCATION
SECTION RANGELAKE/RIVER
CLASS TWP NO.TWP NAMELAKE/RIVER NAMELAKE NUMBER
”^154'2.(^b /3HOTTpr/lTAXU
GRADING / FILLING
□ YES # OF CUBIC YARDS
FIRE NUMBERM L'' ooc 9 - c79^o ^ - GO o
-"OC'O'- o3-{l-ooo
PARCEL NUMBER (S)
5^1S^fKlO
IDENTIFICATION: Please Print All Information TELEPHONE NO.
Mailing Address — No. Street, City, State, and Zip CodeFirstInitial (Daytime)Last Name
Property
Owner
NameContractor
State Lie. It
ONSITE WATER SUPPLY
^ Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3’ (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM
( ) Individual Permit #_____
( ) Collector Permit #_____
J>^TLSD *
PROPOSED USE
( ) Dwelling
P^Non-Dwelling
( ) Water Oriented Accessory Structure
(WOAS)
PROPOSED PROJECT
( ) New Structure(s)
Addition(s)
( ) MH/RV____________
YEAR
CHARACTERISTICS OF NON-DWELLING
( ) Utility Structure
CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING ^ Garage
( ) Boathouse ( ) Screen Porch'(sj Dwelling
( ) Addition to Dwelling
( ) Basehtent
( ) Walkout Basement
Outside \
Dimension_____\
( ) Gazebo ( ) Utility Structure( )Other
Outside
Dimension n Ft. X Ft.( ) Other ,
Outside
DimensionmFt.Ft. X Lotline Setbacks Ft.&.Ft..Ft.
75Lotline Setback!Ft.&Ft.OHWL Setback Ft.
Lotline Setbacks,.Ft.&.Ft.
(^NoOHWL Setback .Ft.Bathroom: ( ) Yes
(If Yes / a complying Sewage System Required)OHWL setback .Ft.
Total Bedrooms yF p, /laximum Height / 35 Ft. (2 story)faximum Height /10 ft. (1 story)Maximum Height story
S-,31, SSq. Ft. Impervious Surface ,Sq. Ft.Impervious Surface RatioLot Area .%1
5/QQ Ft. Elevation of lowest floor above OHWL Ft. (3’ minimum)Water Frontage
^ P To /\LLty
Structure setback to right-of-way Ft. Slope of lot .%
lAStructure setback to septic tank Ft. (10'minimum) (Sewage System Permit required before installation).
xoDwelling setback to Soil Absorption System Ft. (20’minimum) (Sewage System Permit required before installation).
JONon dwelling setback to Soil Absorption System 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) monfhs.
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.
* This permit is only valid after verification from the O. T.L.SD. that a confotpiing sewage sy^em will be Installed to service this lot... Contact Rollle Mann at 864-5533.
Dated:
Signature of Owner
Dated:
Land S Resource Management Office50^PERMIT FEE $RECEIPT NO.
Comments:
A uG c cy^0 ^ 1^/17" JdCcrri -r
Form No. BK — 0597-002 287.685 • Victor Lundeen Co . Printers • Fergus Falls, MN • 1-0OO-346-4B7O
APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENT
OTTER TAIL COUNTY COURT HOUSE
Phone:(218)739-2271 • FERGUS FALLS, MN 56537
WHITE - Office
GOLDENROD - Inspector
'^LLOW~-'Owner
PINK • Assessor
/Permit No.__I^cTS
iMlLjiu/AY
LEGAL
DESCRIPTION
BLUFF ZONEAND
□ YES
NO
LOCATION
LAKE/RIVER
CLASS
SECTION TWP NO.RANGE TWP NAMELAKBRIVEH NAMELAKE NUMBER
'< I
.O IG'bA AT At L~o TTc/irAtU I y-i
GRADING / FILLING
□ YES
'Q NO
FIRE NUMBERPARCEL NUMBER (S)H L ~ OOC 9 ■ C7^G i - GOC
o,q , q - OOO
It OF CUBIC YARDS
C; r.^
IDENTIFICATION: Please Print All Information TELEPHONE NO.
Initial Mailing Address — No. Street, City, State, and Zip CodeFirst (Daytime)Last Name
til. /J1__________
/A/C6\ Ait a) 56 5/S
Property
Owner C\or4 A(_
f
NameContractor
State Lie. H
PROPOSED USE ONSITE WATER SUPPLY
t<) Individual ( ) Public ( ) None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM
( ) Individual Permit #_____
( ) Collector Permit #_____
^KfoTLSD*
PROPOSED PROJECT
( ) New Structure(s)
J(-^) Addition(s)
( ) MH/RV____________
( ) Dwelling
^Non-Dwelling
( ) Water Oriented Accessory Structure
(WOAS)YEAR
CHARACTERISTICS OF NON-DWELLING
( ) Utility Structure
CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING
y/) Garage ( ) Boathouse ( ) Screen Porch( ) Dwelling
( ) Addition to Dwelling
( ) Basement
( ) Walkout Basement
Outside
Dimension
( ) Gazebo ( ) Utility Structure( ) Other
Outside
Dimension _____
K ~]Lotline Setbacks___L
Ft. X .Ft.( ) Other,
Outside
DimensionFt. & Ft.\Ft.
75Lotline Setback^:
OHWL Setback _
OHWL Setback .Ft..Ft.&\Lotline Setbacks Ft.
.Ft.Bathroom: ( ) Yes
(If Yes / a complying Sewage System Required)OHWL Setback..Ft.
Total Bedrooms 7\/Maximum Height / 35 Ft. (2 story)Maximum Height Ft.,Maximum Height / 10 ft. (1 story).storyi
^1, 5,Sq. Ft. Impervious SurfaceLot Area_____
Water Frontage
Structure se'.back to rioht-of-wav ^ 7 Tr. ALLtY
.Sq. Ft.Impervious Surface Ratio .%I1
/OO .Ft. Elevation of lowest floor above OHWL .Ft. (3' minimum)
Ft. Slope of lot .%
lAStructure setback to septic tank Ft. (10’minimum) (Sewage System Permit required before installation).
.Ft. (20’minimum) (Sewage System Permit required before installation).
Ft. (10’minimum) (Sewage System Permit required before installation).
a.QDwelling setback to Soil Absorption System
Non dwelling setback to Soil Absorption System
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 ot 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 responsibiiity to inform the Land & Resource Management office once the building footings have been constructed.
* This permit is only valid after verification from the O.T.LSD. that a conforming sewage system will be installed to service this tot... Contact Rollie Mann at 864-5533.
Signature of Ownar ^
/n - /^-97
Dated:
Dated:
Land & Resource USrragement Office
/y(y/V5PERMIT FEE $RECEIPT NO.
ZiComments:X..L
Form No. BK — 0597-002 267.685 • Victor Lundeert Co . Printers • Fergus Fells. MN • 1-800-346-4B7C
INSPECTION RESULTS
Make all measurements and computations
Structure Set Back from Ordinary High Water Level Ft.Ft.-h 1^0
Structure set Bad< from Top of Bluff Ft.Ft.
AStructure Set Back from Road Right of Way Ft.Ft.
Ft.& 4Structure set Back from Lot Lines Ft.Ft.&Ft.
0-J[Structure Height Ft.Ft.
Structure Set Back from Septic Tank Ft.Ft.
Structure Set Back from Absorption System Ft.Ft.
Eievation Of Lowest Floor Above Ordinary
High Water Level____________________Ft.Ft.
Land Slope at Building Line %%
Inspector’s Comments / Sketch:
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Inspector's Signature
Date of Inspection
l!0‘i
Time of Inspection
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739-2271 - Fergus Falls, Minnesota 56537
APPLICATION FOR SITE PERMIT
WHITE - OfficeGOLDENROD - Inspector
YELLOW - Owner
PINK — Assessor
IQ "1C,L^ 7-ne« TfiiL(y\cB's Permit No„LEGAL
DESCRIPTION
AND
LOCATION
3/ Bj M.cnr&^GOo rrBk WL
TWP NameTWPRangeLake Classif.Sec.Lake NameLake No,
IDENTIFICATION: Please Print All Information
Tel. No.First Zip No.Mailing Address- No. Street. City and StateInitialLast Name
tnpEOwner
(3/rrrLe 3.-sr/^
NameContractor
Architect Name.
NON-RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT: f , RESIDENTIAL PROPOSED USE:
t^eFamilvDwelling
kepit^ce ex/:$nKrs
Specify:,( ) New Building
P'^lteration ( ) Multiple Dwelling Units(
( ) Other ( ) Other Size
IESTIMATED COST OF IMPROVEMENT $
DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME:
Basement: ( ) Yes
Stories above basement: ......
Sq. feet (outside dimension)
..........,
( ) Masonry
(l>y^ood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
( ) Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
(>^f^hidividual Well
, ±LCHARACTERISTICS:
M£t Ipo Maximum depth of lot feet.feet.Water frontage issquare feet.Lot Area is J.5..feet. (Building Line)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 wili be located
3 feet
.s:^.,feet.feet — from road right of way is
lo 1.0 ............feet. ,,
feet from septic tank (Sewage System Permit must be obtained before installation). ‘
feet from soil absorption system (Sewage System Permit must be obtained before installationiy
and
Structure will be located
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
THIS IS A SITE PERMIT ONL Y AND DOES NOT nONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STA TE STA TUTES.
I I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I un
I I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project.
Huisiaiid'^
Dated.
Owner
Permission is hereby granted to the above named applicant to perform the work described in tl It. This permit is granted upon the
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
above state:Permit:
Id--3.- flDated
Shoreland Management OfficialbUfS(fiPermit Fee $.Receipt No.
Comments:
Form No. MKL-0286-019 229971@
VICTOR LUNDEEN CO.. PRINTERS. FERGUS FALLS. MINN.
3X>-1d-SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739 -2271 - Fergus Falls, Minnesota 56537
APPLICATION FOR SITE PERMIT
WHITE - Office
GOLDENROD — Inspector
YELLOW - Owner
PINK — Assessor
IQ ‘tLL
;^es<j/a-T ^
ty)o£ '-s Permit No„LEGAL
DESCRIPTION
AND
LOCATION
3/ 13^ 31 £>7T£ii Tfi'^^L-7Hx g-n^n-TK^L Qo TWP NameTWPRangeSec.Lake Clewsif.Lake NameLake No,
IDENTIFICATION: Please Print AM Information
Tel. No.Zip No.Mailir^ Address— No. Street, City and StateInitialFirstLast Name
iypi\//iLOm/jEOwner
l^/?rTL€ LJ^te m>j
NameContractor
Architect Name.
NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:
( i«1''6ne Family Dwelling
TYPE OF IMPROVEMENT: i ___
Q, (c Jy I I , ) Multiple Dwelling
dei>mcE TtoF
Specify:.( ) New Building
( l>-Kfteration
( ) Other
Units
( )Other Size
IESTIMATED COST OF IMPROVEMENT $
DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME:
L!>lSTiL\<LT
(p<NoBasement: ( ) Yes
Stories above basement:
( ) Public
( ) Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
(>'1''’Tndividual Well
( ) Masonry
( W'Hf/0^ Frame
( ) Structural Steel
( ) Other — Specify
_2...J.^±
Sq. feet (outside dimension)
Bedrooms
rtCHARACTERISTICS:
IPO feet.feet.Maximum depth of lotWater frontage issquare feet.Lot Area is
feet. (Building Line)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
3 feet
9^0S.9...feet.feet — from road right of way is
JO JO...............feet.
.feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Sewage System Permit must be obtained before installation)
and 0^l.£.
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.
THISJS A SITE PERMIT ONL Y AND DOES NOj:X:ONSimJIE^_BUILDING PERMIT AS SET FORTH IN CHAPTER 16. MINNESOTA STA TE STA TUTES.
I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand''^
I must contact my township in order to determine whether or not any additional perrnitsj(re r^uired by the township for my proposed project.^
Dated.
rlwrttwner
Permission is hereby granted to the above named applicant to perform the work described above state . 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.
6.Id- iZ - T/Dated.
Shoreland Management Official
It)\ (nPermit Fee $.Receipt No.
Lot Z) 60)1 Q, miQLjA^itComments:
Form No. MKL-0286-019 229971@
VICTOR LUNDEEN CO.. PRINTERS. FEROUS FALLS. MINN.
r
\
INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL
IS i MINIMUM Shall Be Sq. Ft,
Lot Area (Square feet)Sq. Ft.Sq. Ft.
Water Frontage Ft.Ft.
73" Ft.Building Set Back from High Water Mark Ft.
y^'l’ H.Building Set Back from State Highway Ft.5a
f ^0Building Set Back from Street or Road P^a 40“ Ft.Ft.
■^jO iO Ft./2> & / O Ft.Side Yard
Rear Yard Ft.Ft.
/OOccupied Building to Septic Tank Ft.10 Ft.
/ Ft.Occupied Building to Absorption System 20 Ft.
Elevation at Building Line above
High Water Mark_____________Ft.3 Ft.
Inspector's Comments: // X 1% 4Y~ 0
DiL/iX^JX pt\X- a.JL(^JLylAJ&-^ Ag ha L-e^
/^r /H6 •€, . <a pcutA
'f-a^
,inspectors Signature
Title
Inspection
Dated H-^ih 19
Agency
wcT*B urmcN • M.. M<wft«*. rct«m r«uj. wm.
y
J
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739-2271 — Fergus Falls, Minnesota 56537
APPLICATION FOR SITE PERMIT
WHITE - Office
GOLDENROD — Inspector
YELLOW - Owner
PINK — Assessor
TumPermit No,.LEGAL
DESCRIPTION
SIS'AND
LOCATION
SLrSS DHfenraJ W 3 (3^
Ran^e TWP NameSec.TWPLake Classif.Lake NameLake No.
IDENTIFICATtON: Please Print Ail Information
Tel. No-Last Name________ _________ FirstIhvtijd Zip No,IVIailing Address— No, Street, City and StateInitial
#
Owner
5NameContractor
Architect Name.
}NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT:J
/m Specify;.( ) New Building
f>—l-Slt^tion
( ) One Family Dwelling
( ) Multiple Dwelling Units
( ) Other( )Other Size
ESTIMATED COST OF IMPROVEMENT $
DIMENSIONS:TYPE OF SEWAGE DISPOSAL;PRINCIPAL TYPE OF FRAME:
/( ) Yes (LL-Wo^( ) Masonry
(L-FWood Frame
( ) Structural Steel
( ) Other — Specify
Basement:( ) Public
( I Individual Septic Tank, etc.
WATER SUPPLY;
( ) Public
( ) Individual Well
Stories above basement;
Sq. feet (outside dimension)
Bedroorhs ../SStS...............Baths
CHARACTERISTICS:
Maximum depth of lot feet.feet.Water frontage issquare feet.Lot Area is 7^feet. (Building Line)Building set back from high water mark is....................
Land height above high water mark at building line is
Building set back from Stqte highway right of way....
Side yard is ............
Structure will be located
feet
.30.feet.feet — from road right of way is
feet.
.feet from septic tank (Sewage System Permit must be obtained before installation).
....feet from soil absorption system (Sewage System Permit must be obtained before installation).
and
LQ.
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.
_THISJS.A.Si^E PERMIT ONL Y AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNBS&TTTStAl k SIAlUlbS:—■
I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand
I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project.
Dated.
Signature of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
Dated
Shoreland Management Official
I0II17Permit Fee $.Receipt No.
Comments;
Form No. MKL-0286-019 229971(g)
VICTOR LUNOEEN CO.. PRINTERS. FERGUS FALLS. MINN.
0^SHORELANO MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone: (218) 739-2271 — Fergus Falls, Minnesota 56537
APPLICATION FOR SITE PERMIT
WHITE - Office
60LDENROD — Inspector
YELLOW — Owner
PINK — Assessor
TomPermit No„LEGAL
K~e5d^-tDESCRIPTION
AND
LOCATION
(yfy> 3 m
Range
l /
TWP NameSec.TWPLake Clastlf.Lake NameLake No,
IDENTIFICATION: Please Print Ail Information
Tel. No.Zip No.Mailing Address— No. Street. City and StateInitial
ijt'ilaidLast Name
Owner
r'
NameContractor cT
Architect Name.
I NON-RESIOENTIAL PROPOSED USE;RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT:
Specify:.( ) One Family Dwelling
( ) Multiple Dwelling
1 ) New Building
f—^Alteration Units
( ) Other SizeI ) Other
ESTIMATED COST OF IMPROVEMENt|$
DIMENSIONS:TYPE OF SEWAGE DISPOSAL;PRINCIPAL TYPE OF FRAME:
/Basement: ( ) Yes (LJJJe'
Stories above basement:
Sq. feet (outside (pension)
Bedrooms
( ) Public
( ) Individual Septic Tank, etc.
WATER SUPPLY;
( ) Public
( ) Individual Well
( ) Masonry
(L^Wood Frame
( ) Structural Steel
( ) Other — Specify Baths ../TT
CHARACTERISTICS;
feet.Maximum depth of lot feet.Water frontage is^^.square feet.Lot Area is
.7^feet. (Building Line)Building set back from high water mark is....................
Land height above high water mark at building line is
Building set back from ^te highway right of way....
Side yard is ............and............................Structure will be located........^...(^.
~sf:feet
.30..feet.feet — from road right of way is
feet.
...................feet from septic tank (Sewage System Permit must be obtained before installation).
........feet from soil absorption system (Sewage System Permit must be obtained before installation).Structure will be located
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
THISJS A^E PERMIT ONL Y AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16, MINNESOTA STA TE STATUTESr—j,
I understand that I have been granted a site permit in accordance with the requirements of the Shoreland Management Ordinance of Otter Tail County. I understand
I must contact my township in order to determine whether or not any additional permits are required by the township for my proposed project.
Dated.
Signature of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit;
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
Ck>unty, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
y-'zq-w
_ Receipt No. j / \ '7 ^
Dated
Shoreland Management Official
Permit Fee $.
T
Comments:
Form No. MKL-0286-019 229971@
VICTOR LUNDEEN CO.. PRINTERS, FERGUS PALLS. MINN.
.-••ry
-r-- . ■•''m^",’ -IT-t.^; —«7- —• '«»»^v*3P“''rj-
INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL IS 1 MINIMUM
Shall Be 4,Sq. Ft
Sq. Ft.Lot Area (Square feet) r~H Sq. Ft.
^1CJ' Ft.Water Frontage Ft.
! OO ~Building Set Back from High Water Mark Ft.Ft.
^ /Building Set Back from State Highway Ft.50 Ft.
//: ABuilding Set Back from Street or Road Ft.40 Ft.
/^ & / d Ft.&Side Yard Ft.
/7/CRear Yard Ft.Ft.
Occupied Building to Septic Tank 10 Ft.
0. Ft.Occupied Building to Absorption System 20 Ft.
Elevation at Building Line above
High Water Mark_____________Ft.3 Ft.
Inspector's Comments:
Inspector'* Signature
Title
Inspection
Dated _'iSf-/6
Agency
«tCT«« uimcu « M.. MIWIVM. Kfttw* fiU*. W*M.
- I- f!I
Scale: Each grid equals feet/inches GRID PLOT PLAN SKETCHING FORM
Dated: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.
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MKL-08T71-029 21S98 7@ VICTO* LUNOtCN CO.. PRINTERS. PERGUS FALLS. UINN.
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„LEGAL
^ p /DateDESCRIPTION
I M i D wr)-^ P^/?k. JLc^i t ^ ^
AND
LOCATION
Lake No. Lake Classif.Sec.TWPLake Name TWP NameRange
IDENTIFICATION: Please Print All Information
Last Name First Initial Mailing Address— No. Street. City and State Zip No.Tel. No.
ir\c£Owner
^ ENameContractor
Architect Name.
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:
^AOne Family Dwelling
( ) Multiple Dwelling
( ) Other
NON-RESIOENTIAL PROPOSED USE:
Specify: £ S ^ X"________----
ti.
( ) New Building
^Xi Alteration
( )Other
Units
Size
ESTIMATED COST OF IMPROVEMENTS (omit cents)
DIMENSIONS:
Basement: ( ) Yes PC) No
Stories above basement:
Sq. feet (outside dimension)
Bedrooms
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:
( ) Masonry
f)() Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
0^) Individual Septic Tank
WATER SUPPLY:
I ) Public
(^C. Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
/, etc.
I..SL.Baths
HEATING:
( ) Electric
I ) Coal
Other:
(3^ NoType of Roof:Gas
( ) None
( ) Oil
iX No
( ) Unit
CHARACTERISTICS:
Lot Area is
Building set back from high water mark is......
Land height above high water mark at building line is
Building set back from State highway is
Side yard is
Building will be located
Building will be located
square feet.Water frontage is.
feet. (Building Line)
................................feet
feet.
.3
9^feet — from road or street is feet.
1.0 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.
Signature of Owr^r
/O - 9Dated.
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.
y.7 - .f- iyDated
Shop^K^Management Official
State Surcliarge $.Permit Fee
Comments;
C ^ /
e
//a.
_ __
Form No. MKL-0771-002 vicT«« umeciM 4 eo.. Fman•*. rcitau* r<^Li. hihm.158899