HomeMy WebLinkAboutPleasant Lake Resort_57000060041001_Shoreland Permits_APPLICATION FOR SITE PERMIT
LAND & RESOURCE MANAGEMENTOTTER TAIL COUNTY COURT HOUSE
Phone:(218) 739-2271 • FERGUS FALLS, MN 56537
WHITE - Office
GOLDENROD ■ Inspector
YELLOW - Owner
PINK - Assessor
A'fJOPermit No.(^L V
<L(^l C ^TrZ.
LEGAL
A,DESCRIPTION
BLUFF ZONEAND
□ YES
[Sno
LOCATION
SECTION TWP NO.RANGE TWP NAMELAKE/RIVER
CLASSLAKE/RIVER NAME// ///e. ^Uala*i4'LAKE NUMBER
6 !3i(ZO V /^L-IIX7
GRADING / FILLING
M YES
□ NO
FIRE NUMBERPARCEL NUMBER (S)l?oojJ-oco-06-00^1 -oc I » OF CUBIC YARDS
IDENTIFICATION: Please Print All Information TELEPHONE NO.
Mailing Address — No. Street. City, State, and Zip Code (Daytime)First InitialLast Name
Property
Owner
(J/C U'CtfC\ j /yi/O
NameContractor
State Lie. #
ONSITE WATER SUPPLY
(^Individual ( ) Public '■j^'None
NOTE: MN Rules Chpt. 4725 (MN Well
Code) requires a 3' (minimum) structure
setback to a well.
ONSITE SEWAGE
TREATMENT SYSTEM
(^'Individual Permit * ^‘YTTf
( ) Collector Permit #___________
( )OTLSD*
PROPOSED USE
( ) Dwelling
(^JJNon-Dwelling
( ) Water Oriented Accessory Structure
(WOAS)
PROPOSED PROJECT
(^New Structure(s)
( ) Addition(s)
( )MH/RV____________YEAR
CHARACTERISTICS OF NON-DWELLING
( ) Garage ( ) Utility Structure
CHARACTERISTICS OF WOASCHARACTERISTICS OF DWELLING
( ) Boathouse ( ) Screen Porch( ) Dwelling
( ) Addition to Dwelling
( ) Basement
( ) Walkout Basement
OutsideDimension________/
so
—^ Dimension
Us ( ) Gazebo ( ) Utility Structure(^^ Other
Outside
Dimension
70J ^ Ft. &.Ft.Ft. X Lotline Setbacks Ft. X .Ft.y
.Ft.Lotline Setbacks.Ft.&.Ft.OHWL Setback Lotline Setbacks .Ft.&.Ft.
.Ft.OHWL Setback Bathroom: ( ) Yes l*^) No
(If Yes / a complying Sewage System Required)^WL Setback..Ft.
TotaJ/Bedrooms
laximum Height / 35 Ft. (2 story) Maximum Height /10 ft. (1 story)Maximum Hei .story
+So-OOL ,Sq. Ft. Impervious Surface RatioSq. Ft. Impervious Surface .%Lot Area
.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___
Non dwelling setback to Soil Absorption System LO 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.
* This permit is only valid after verification from the O.T.L.SD. that a conforming sewage system will be installed to service this lot... Contact Rollie Mann at 864-5533.
S-Dated:
Signature of Owner
Dated:
Land & Resource Management Office
RECEIPT NO.PERMIT FEE $
Comments:
Form No. BK — 0597-002 287.685 • Victor Lundeen Co. Printers * Fergus Falls. MN ■ 1-800-346-4670
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