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Home My WebLink AboutPeterson Pelican Lake HOL_17000991130000_Shoreland Permits_APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE — Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessor tits'! 3) ?\r (^sn _ , ^ ,, ~Zv^\sa^ ILEGAL Permit No. DESCRIPTION AND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER CLASS .LcpM SECTION TWP NO.RANGE TWP NAME /7 /57 PARCEL NUMBER (S)FIRE OR LAKE ASSOCIATION NUMBER^0/3 -/7-6V3P ------- /1 -COO // / OCO /11- 000-^9-//30^ IDENTIFICATION: Please Print AM Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. QentnnkM /hsz.i>o ,‘StWiscn 22i?^Property Owner + 53NameContractor State Lie. # PROPOSED PROJECT PROPOSED USE ( K) Residential ( ) Non-Residential RESIDENTIAL USE I^N-RESIDENTIAL USE ( Nl Garage ( ) CKjlity Structure CHARACTERISES OF PROPOSED ( ) New Structure ( ) Addition Family Dwelling ( ) Multiple Dwelling # of Units ( ) Basement ( Walkout Basement ( Outside Dimension . . — of Structure f T_ Height of Structure Ft. # Of Stories # Of Bedrooms /whJrv TYPE OF FRAME ( ) Masonry ( ) Wood ( ) Structural Steel Other ( ) Waten^rientated AccessSiry StructureCK)YEAR ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY (JPI’Public (f>^ Individual ( ) None ( ) Other ,fj i-OFFICE USE ONLY Bluff Impact Zone ) Shore Impact Zone ) Sensitive Area ji Public Individual Permit It. ( ) OTLSD /'1^1^# Of Bathroomsti( LOT SIZE AND SETBACKS: square feet. Water frontageLot Area is feet. Maximum depth of lot feet. Building set back from ordinary high water level is feet. (String Test) Land height above ordinary high water level at building line is feet. Slope of lot % 7ZlBuilding set back from road right-of-way.A- Lot line setback is and Structure will be located 3J OK. —d-sr 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).2cstructure will be located. THIS fS A SITE PERMIT ONLY AND DOES NOT CONSTITUTE A BUILDING PERMIT AS SET FORTH IN CHAPTER 16. MINNESOTA STATE STATUTES. Agreement: l 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 accord ing 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 (I understand that It Is my responsibility to inform the Land & Resource Management office once the building footings have been constructed.) 3; Dated: SIgpeiure orOwner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. Dated: Land A Resource Management OfficeoO30^Permit Fee $.Receipt No„ Comments:r Form No. BK — 0292-002 270.500 ■ Victor Lundeen Co Printers • Fergus Fells. MN • 1-800-346-4670 A- APPLICATION FOR SITE PERMIT LAND & RESOURCE MANAGEMENT OTTER TAIL COUNTY COURT HOUSE Phone: (218) 739-2271 • FERGUS FALLS, MN 56537 WHITE — Office GOLDENROD — Inspector YELLOW — Owner PINK — Assessorf IWl• Vv/Oo^j 6LciJ ' Y\ ^4 ( 3j 6,^ n LECAL Permit No.tiluU'3 ^t DESCRIPTION AND LOCATION LAKE NUMBER LAKE/RIVER NAME LAKE/RIVER SECTION TWP NO.RANGE TWP NAME bt 7 /by/I itj PARCEL NUMBER (S)FIRE OR LAKE ASSOCIATION NUMBER II I f - OCO / / 7 -OOa-<fq< -//3o 'GOoJ7/ 7 -Oc^l-l. IDENTIFICATION: Please Print All Information Last Name First Initial Mailing Address — No. Street, City and State Zip Code Telephone No. I2^n ’Qe/-)tnn^4j.Property Owner / ■iT NameContractor State Lie. #r PROPOSED PROJECT PROPOSED USE ( ^) Residential ( ) Non-Residential RESIDENTIAL USE N^N-RESIDENTIAL USE ( T^arage ( ) Lhllity Structure CHARACTERISTIC OF PROPOSED Basement ( ^) Walkout Basement ( Outside Dimensi of Structure__ Height of Structure /^ Ft. # Of Stories li(t?^«)4^ne Family Dwelling ( ) Multiple Dwelling It of Units ( ) ( ) New Structure ( ) Edition LX)/mh/rv \ () Water Orientated Accessory Structure ) Other 'V fT xr^^Ft.YEAR! TYPE OF FRAME ( ) Masonry ( ) Wood !ONSITE SEWAGE DISPOSAL SYSTEM ONSITE WATER SUPPLY (0^ Public (*><j Individual (i■i a)1/OFFICE USE OnLy (' '' j) Bluff Impact Zone ( f'-') Shore Impact Zone ( [\j) Sensitive Area M Public A# Of Bedrooms ;Individual Permit #. ( ) OTLSD /( ) Structural Steel Other ) None # Of Bathrooms LOT SIZE AND SETBACKS: feet. ^ ^Lot Area is square feet. Water frontage is feet. Maximum depth of lot Building set back from ordinary high water level is feet. (String Test) Land height above ordinary high water level at building line is Building set back from road right-of-way. feet. Slope of lot L/tLot line setback is and 5irie^ errStructure will be located 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). ^2o 1 Structure will be located rTHIS 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 accord ing 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 (I understand that it is my responsibility to inform the Land ft Resource Management office once the building footings have been constructed ) ■' ZLi____ ■1<7 iDated:'i Sigimture or uwner Permit: Permission is hereby granted to the above named applicant to perform the work described in the above statement. 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 Ordinance of Otter Tail County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. ^'7Cv_ Dated: Land & Resource Management OfficeoO/50^/7 IPermit Fee $.Receipt No_ Comments:-t-r > 4\/ -/i 1I\V I /i 4- i .1 Form No. BK — 0292>002 2 70.500 ■ Victor Lundeen Co Printers • Fergus Fells. MN • 1-80O34&-4870 INSPECTION RESULTS Make all measurements and computations ACTUAL MINIMUM Sq. Ft. Building Set Back from High Water Level Ft.Ft. Building Set Back from Top of Bluff Ft.30 Ft. Building Set Back from Road Right of Way Ft.20 Ft. y50'!'t Ft.Ft. &Ft.Building Set Back from Lot Lines a /o'Ft. Ft.Building Height Building Set Back from Septic Tank Ft.10 Ft Building Set Back from Absorption System Ft.20 Ft Elevation Above High Water Level at Building Line 3 Ft.3 Ft. Land Slope at Building Line % 4u' to \k>u)ivcr IsInspector's Comments/Sketch: (//e?54 n// As sl)0U^n Hi rAwi litio^i Tr4,llr h-eki/jj ^ hcA/^iOtJ /^ZrZft-d COH^oZ//^^ » %y m./ / 1^ i ■ / / v/^ 1^' [ \ d 4 Ui/lf Inspector's Signature€.aJ s >An Date of In C Time of Inspection ^4 \ v~IIIII I I I 3i^ I I l_ El P^Gf^S^ a 0ct~e^^iA/G Ht>u5^nI/ C/IBIN y* L /a/^CJATS^ JJ'-ZO'S= ssPn-uL TAa^K